OBJECTIVE: Respiratory support status is critical in understanding patient status, but electronic health record data are often scattered, incomplete, and contradictory. Further, there has been limited work on standardizing representations for respiratory support. The objective of this work was to (1) propose a practical terminology system for respiratory support methods; (2) develop (meta-)heuristics for constructing respiratory support episodes; and (3) evaluate the utility of respiratory support information for mortality prediction. MATERIALS AND METHODS: All analyses were performed using electronic health record data of COVID-19-tested, emergency department-admit, adult patients at a large, Midwestern healthcare system between March 1, 2020 and April 1, 2021. Logistic regression and XGBoost models were trained with and without respiratory support information, and performance metrics were compared. Importance of respiratory-support-based features was explored using absolute coefficient values for logistic regression and SHapley Additive exPlanations values for the XGBoost model. RESULTS: The proposed terminology system for respiratory support methods is as follows: Low-Flow Oxygen Therapy (LFOT), High-Flow Oxygen Therapy (HFOT), Non-Invasive Mechanical Ventilation (NIMV), Invasive Mechanical Ventilation (IMV), and ExtraCorporeal Membrane Oxygenation (ECMO). The addition of respiratory support information significantly improved mortality prediction (logistic regression area under receiver operating characteristic curve, median [IQR] from 0.855 [0.852-0.855] to 0.881 [0.876-0.884]; area under precision recall curve from 0.262 [0.245-0.268] to 0.319 [0.313-0.325], both P < 0.01). The proposed generalizable, interpretable, and episodic representation had commensurate performance compared to alternate representations despite loss of granularity. Respiratory support features were among the most important in both models. CONCLUSION: Respiratory support information is critical in understanding patient status and can facilitate downstream analyses.

Machine learning techniques have shown promise in predicting clinical deterioration of hospitalized patients based on electronic health record (EHR). However, building accurate early warning systems (EWS) remains challenging in practice. EHRs are heterogeneous, comprising both static and time-series data. Moreover, missing values are prevalent in both static and time-series data, and the missingness of certain data can be correlated to clinical outcomes. This paper proposes a novel approach for integrating static and time-series clinical data in deep recurrent models through multi-modal fusion. Furthermore, we exploit the correlation of static and time-series data through cross-modal imputation in an integrated recurrent model. We apply the proposed approaches to a dataset extracted from the EHR of 20,700 hospitalizations of adult oncology patients in a research hospital. The experiments demonstrate the proposed approaches outperform the state-of-the-art models in terms of predictive accuracy in generating early warnings for clinical deterioration. A case study further establishes the efficacy of the predictive model for early warning systems under realistic clinical settings.

Machine learning and data mining techniques are increasingly being applied to electronic health record (EHR) data to discover underlying patterns and make predictions for clinical use. For instance, these data may be evaluated to predict clinical deterioration events such as cardiopulmonary arrest or escalation of care to the intensive care unit (ICU). In clinical practice, early warning systems with multiple time horizons could indicate different levels of urgency, allowing clinicians to make decisions regarding triage, testing, and interventions for patients at risk of poor outcomes. These different horizon alerts are related and have intrinsic dependencies, which elicit multi-task learning. In this paper, we investigate approaches to properly train deep multi-task models for predicting clinical deterioration events via generating multi-horizon alerts for hospitalized patients outside the ICU, with particular application to oncology patients. Prior knowledge is used as a regularization to exploit the positive effects from the task relatedness. Simultaneously, we propose task-specific loss balancing to reduce the negative effects when optimizing the joint loss function of deep multi-task models. In addition, we demonstrate the effectiveness of the feature-generating techniques from prediction outcome interpretation. To evaluate the model performance of predicting multi-horizon deterioration alerts in a real world scenario, we apply our approaches to the EHR data from 20,700 hospitalizations of adult oncology patients. These patients' baseline high-risk status provides a unique opportunity: the application of an accurate model to an enriched population could produce improved positive predictive value and reduce false positive alerts. With our dataset, the model applying all proposed learning techniques achieves the best performance compared with common models previously developed for clinical deterioration warning.

In the article, we explore the feasibility of monitoring outpatients using Fitbit Charge HR wristbands and the potential of machine learning models to predict clinical deterioration (readmissions and death) among outpatients discharged from the hospital. We developed and piloted a data collection system in a clinical study that involved 25 heart failure patients recently discharged. The results demonstrated the feasibility of continuously monitoring outpatients using wristbands. We observed high levels of patient compliance in wearing the wristbands regularly and satisfactory yield, latency, and reliability of data collection from the wristbands to a cloud-based database. Finally, we explored a set of machine learning models to predict deterioration based on the Fitbit data. Through fivefold cross-validation, K nearest neighbor achieved the highest accuracy of 0.8667 for identifying patients at risk of deterioration using the data collected from the beginning of the monitoring. Machine learning models based on multimodal data (step, sleep, and heart rate) significantly outperformed the traditional clinical approach based on LACE index. Moreover, our proposed Weighted Samples One-Class SVM model with estimated confidence can reach high accuracy (0.9635) for predicting the deterioration using data collected within a sliding window, which indicates the potential for allowing timely intervention.

Objective: To review and analyze the literature to determine whether wearable technologies can predict health outcomes. Materials and methods: We queried Ovid Medline 1946 -, Embase 1947 -, Scopus 1823 -, the Cochrane Library, clinicaltrials.gov 1997 - April 17, 2018, and IEEE Xplore Digital Library and Engineering Village through April 18, 2018, for studies utilizing wearable technology in clinical outcome prediction. Studies were deemed relevant to the research question if they involved human subjects, used wearable technology that tracked a health-related parameter, and incorporated data from wearable technology into a predictive model of mortality, readmission, and/or emergency department (ED) visits. Results: Eight unique studies were directly related to the research question, and all were of at least moderate quality. Six studies developed models for readmission and two for mortality. In each of the eight studies, data obtained from wearable technology were predictive of or significantly associated with the tracked outcome. Discussion: Only eight unique studies incorporated wearable technology data into predictive models. The eight studies were of moderate quality or higher and thereby provide proof of concept for the use of wearable technology in developing models that predict clinical outcomes. Conclusion: Wearable technology has significant potential to assist in predicting clinical outcomes, but needs further study. Well-designed clinical trials that incorporate data from wearable technology into clinical outcome prediction models are required to realize the opportunities of this advancing technology.

Clinical study found that early detection and intervention are essential for preventing clinical deterioration in patients, for patients both in intensive care units (ICU) as well as in general wards but under real-time data sensing (RDS). In this paper, we develop an integrated data mining approach to give early deterioration warnings for patients under real-time monitoring in ICU and RDS.