Rule-Based Identification of Individuals with Mild Cognitive Impairment or Alzheimer’s Disease Using Clinical Notes from the United States Veterans Affairs Healthcare System
Abstract Background Early identification of individuals with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) is a clinical and research imperative. Use of diagnostic codes for MCI and AD identification has limitations. We used clinical notes to supplement diagnostic codes in the Veteran...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Adis, Springer Healthcare
2023-09-01
|
| Series: | Neurology and Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1007/s40120-023-00540-2 |
| _version_ | 1797629862814416896 |
|---|---|
| author | Byron J. Aguilar Donald Miller Guneet Jasuja Xuyang Li Ekaterina Shishova Maureen K. O’Connor Andrew Nguyen Peter Morin Dan Berlowitz Raymond Zhang Amir Abbas Tahami Monfared Quanwu Zhang Weiming Xia |
| author_facet | Byron J. Aguilar Donald Miller Guneet Jasuja Xuyang Li Ekaterina Shishova Maureen K. O’Connor Andrew Nguyen Peter Morin Dan Berlowitz Raymond Zhang Amir Abbas Tahami Monfared Quanwu Zhang Weiming Xia |
| author_sort | Byron J. Aguilar |
| collection | DOAJ |
| description | Abstract Background Early identification of individuals with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) is a clinical and research imperative. Use of diagnostic codes for MCI and AD identification has limitations. We used clinical notes to supplement diagnostic codes in the Veterans Affairs Healthcare System (VAHS) electronic health records (EHR) to identify and establish cohorts of Veterans recorded with MCI or AD. Methods Targeted keyword searches for MCI (“Mild cognitive impairment;” “MCI”) and AD (“Alz*”) were used to extract clinical notes from the VAHS EHR from fiscal year (FY) 2010 through FY 2019. Iterative steps of inclusion and exclusion were applied until searches achieved a positive predictive value ≥ 80%. MCI and AD cohorts were identified via clinical notes and/or diagnostic codes (i.e., including Veterans recorded by “Notes Only,” “Notes + Code,” or “Codes Only”). Results A total of 2,134,661 clinical notes from 339,007 Veterans met the iterative search criteria for MCI due to any cause and 4,231,933 notes from 572,063 Veterans met the iterative search criteria for AD. Over the 10-year study period, the number of clinical notes recording AD was generally stable, whereas the number for MCI more than doubled. More Veterans were identified for the MCI or AD cohorts via clinical notes than by diagnostic codes, particularly in the AD cohort. Among Veterans identified by having “Notes + Code” for MCI, the number first recorded by a code was lower than the number first recorded by a note until FY 2015 and then gradually became comparable after FY 2015. Among Veterans identified by having “Notes + Code” for AD, the number first recorded by a note was more than double the number first recorded by a code AD in each of the FYs. Conclusions Clinical note-based identification captured more Veterans recorded with MCI and AD than diagnostic code-based identification. |
| first_indexed | 2024-03-11T10:59:46Z |
| format | Article |
| id | doaj.art-072898b7436d4a0cb86f779e10daaa81 |
| institution | Directory Open Access Journal |
| issn | 2193-8253 2193-6536 |
| language | English |
| last_indexed | 2024-03-11T10:59:46Z |
| publishDate | 2023-09-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Neurology and Therapy |
| spelling | doaj.art-072898b7436d4a0cb86f779e10daaa812023-11-12T12:34:10ZengAdis, Springer HealthcareNeurology and Therapy2193-82532193-65362023-09-011262067207810.1007/s40120-023-00540-2Rule-Based Identification of Individuals with Mild Cognitive Impairment or Alzheimer’s Disease Using Clinical Notes from the United States Veterans Affairs Healthcare SystemByron J. Aguilar0Donald Miller1Guneet Jasuja2Xuyang Li3Ekaterina Shishova4Maureen K. O’Connor5Andrew Nguyen6Peter Morin7Dan Berlowitz8Raymond Zhang9Amir Abbas Tahami Monfared10Quanwu Zhang11Weiming Xia12Geriatric Research Education and Clinical Center, VA Bedford Healthcare SystemZuckerberg College of Health Sciences, University of Massachusetts LowellCenter for Healthcare Organization and Implementation, VA Bedford Healthcare SystemGeriatric Research Education and Clinical Center, VA Bedford Healthcare SystemZuckerberg College of Health Sciences, University of Massachusetts LowellGeriatric Research Education and Clinical Center, VA Bedford Healthcare SystemGeriatric Research Education and Clinical Center, VA Bedford Healthcare SystemDepartment of Neurology, Boston University Chobanian & Avedisian School of MedicineZuckerberg College of Health Sciences, University of Massachusetts LowellAlzheimer’s Disease and Brain Health, Eisai Inc.Alzheimer’s Disease and Brain Health, Eisai Inc.Alzheimer’s Disease and Brain Health, Eisai Inc.Geriatric Research Education and Clinical Center, VA Bedford Healthcare SystemAbstract Background Early identification of individuals with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) is a clinical and research imperative. Use of diagnostic codes for MCI and AD identification has limitations. We used clinical notes to supplement diagnostic codes in the Veterans Affairs Healthcare System (VAHS) electronic health records (EHR) to identify and establish cohorts of Veterans recorded with MCI or AD. Methods Targeted keyword searches for MCI (“Mild cognitive impairment;” “MCI”) and AD (“Alz*”) were used to extract clinical notes from the VAHS EHR from fiscal year (FY) 2010 through FY 2019. Iterative steps of inclusion and exclusion were applied until searches achieved a positive predictive value ≥ 80%. MCI and AD cohorts were identified via clinical notes and/or diagnostic codes (i.e., including Veterans recorded by “Notes Only,” “Notes + Code,” or “Codes Only”). Results A total of 2,134,661 clinical notes from 339,007 Veterans met the iterative search criteria for MCI due to any cause and 4,231,933 notes from 572,063 Veterans met the iterative search criteria for AD. Over the 10-year study period, the number of clinical notes recording AD was generally stable, whereas the number for MCI more than doubled. More Veterans were identified for the MCI or AD cohorts via clinical notes than by diagnostic codes, particularly in the AD cohort. Among Veterans identified by having “Notes + Code” for MCI, the number first recorded by a code was lower than the number first recorded by a note until FY 2015 and then gradually became comparable after FY 2015. Among Veterans identified by having “Notes + Code” for AD, the number first recorded by a note was more than double the number first recorded by a code AD in each of the FYs. Conclusions Clinical note-based identification captured more Veterans recorded with MCI and AD than diagnostic code-based identification.https://doi.org/10.1007/s40120-023-00540-2Alzheimer’s diseaseMild cognitive impairmentRule-based processingVeteran |
| spellingShingle | Byron J. Aguilar Donald Miller Guneet Jasuja Xuyang Li Ekaterina Shishova Maureen K. O’Connor Andrew Nguyen Peter Morin Dan Berlowitz Raymond Zhang Amir Abbas Tahami Monfared Quanwu Zhang Weiming Xia Rule-Based Identification of Individuals with Mild Cognitive Impairment or Alzheimer’s Disease Using Clinical Notes from the United States Veterans Affairs Healthcare System Neurology and Therapy Alzheimer’s disease Mild cognitive impairment Rule-based processing Veteran |
| title | Rule-Based Identification of Individuals with Mild Cognitive Impairment or Alzheimer’s Disease Using Clinical Notes from the United States Veterans Affairs Healthcare System |
| title_full | Rule-Based Identification of Individuals with Mild Cognitive Impairment or Alzheimer’s Disease Using Clinical Notes from the United States Veterans Affairs Healthcare System |
| title_fullStr | Rule-Based Identification of Individuals with Mild Cognitive Impairment or Alzheimer’s Disease Using Clinical Notes from the United States Veterans Affairs Healthcare System |
| title_full_unstemmed | Rule-Based Identification of Individuals with Mild Cognitive Impairment or Alzheimer’s Disease Using Clinical Notes from the United States Veterans Affairs Healthcare System |
| title_short | Rule-Based Identification of Individuals with Mild Cognitive Impairment or Alzheimer’s Disease Using Clinical Notes from the United States Veterans Affairs Healthcare System |
| title_sort | rule based identification of individuals with mild cognitive impairment or alzheimer s disease using clinical notes from the united states veterans affairs healthcare system |
| topic | Alzheimer’s disease Mild cognitive impairment Rule-based processing Veteran |
| url | https://doi.org/10.1007/s40120-023-00540-2 |
| work_keys_str_mv | AT byronjaguilar rulebasedidentificationofindividualswithmildcognitiveimpairmentoralzheimersdiseaseusingclinicalnotesfromtheunitedstatesveteransaffairshealthcaresystem AT donaldmiller rulebasedidentificationofindividualswithmildcognitiveimpairmentoralzheimersdiseaseusingclinicalnotesfromtheunitedstatesveteransaffairshealthcaresystem AT guneetjasuja rulebasedidentificationofindividualswithmildcognitiveimpairmentoralzheimersdiseaseusingclinicalnotesfromtheunitedstatesveteransaffairshealthcaresystem AT xuyangli rulebasedidentificationofindividualswithmildcognitiveimpairmentoralzheimersdiseaseusingclinicalnotesfromtheunitedstatesveteransaffairshealthcaresystem AT ekaterinashishova rulebasedidentificationofindividualswithmildcognitiveimpairmentoralzheimersdiseaseusingclinicalnotesfromtheunitedstatesveteransaffairshealthcaresystem AT maureenkoconnor rulebasedidentificationofindividualswithmildcognitiveimpairmentoralzheimersdiseaseusingclinicalnotesfromtheunitedstatesveteransaffairshealthcaresystem AT andrewnguyen rulebasedidentificationofindividualswithmildcognitiveimpairmentoralzheimersdiseaseusingclinicalnotesfromtheunitedstatesveteransaffairshealthcaresystem AT petermorin rulebasedidentificationofindividualswithmildcognitiveimpairmentoralzheimersdiseaseusingclinicalnotesfromtheunitedstatesveteransaffairshealthcaresystem AT danberlowitz rulebasedidentificationofindividualswithmildcognitiveimpairmentoralzheimersdiseaseusingclinicalnotesfromtheunitedstatesveteransaffairshealthcaresystem AT raymondzhang rulebasedidentificationofindividualswithmildcognitiveimpairmentoralzheimersdiseaseusingclinicalnotesfromtheunitedstatesveteransaffairshealthcaresystem AT amirabbastahamimonfared rulebasedidentificationofindividualswithmildcognitiveimpairmentoralzheimersdiseaseusingclinicalnotesfromtheunitedstatesveteransaffairshealthcaresystem AT quanwuzhang rulebasedidentificationofindividualswithmildcognitiveimpairmentoralzheimersdiseaseusingclinicalnotesfromtheunitedstatesveteransaffairshealthcaresystem AT weimingxia rulebasedidentificationofindividualswithmildcognitiveimpairmentoralzheimersdiseaseusingclinicalnotesfromtheunitedstatesveteransaffairshealthcaresystem |