Index of Non-Adherence

Computational analysis of non-adherence and non-attendance using the text of narrative physician notes in the electronic medical record.

Turchin A, Kolatkar NS, Pendergrass ML, Kohane IS. Medical Informatics and the Internet in Medicine 2007 Jun;32(2):93-102.

To Be Edited Further

Question Does the non-adherence of patients to physician recommendations create poor clinical outcomes?

Method/Data Sources The authors developed software that allowed them analyze physician's a large number of free text notes for patient non-adherence. They compared that to patient Emergency Room visits to determine the outcome for non-adherence.

• Data
  • Clinical Outcomes is measured by subsequent Emergency Room visits adjusted for a number of factors
  • Created software to quantitatively measure the compliance based on physician’s free text notes.
  • Limited records to those that show possible chronic disease
    • (mainly hypertension and diabetes mellitus.)
  • Limited chronic records to those that had been seen regularly.
    • Those with more than a base amount of cancer were excluded as their compliance was not expected to be measured in visits to the ER
  • Identified singular physician notes and the sentences within
  • Identified 14 phrases that indicate non-adherence.
  • Verified manually
• Method
  • Index of Non-Adherence is the ratio of non-adherence sentences over the total number of sentences.
  • Other Indices were also created.
  • Various statistical methods (positive predictive rates) were used to extrapolate manual verification.

Main Results Created software and processes that can measure and monitor patient non-adherence as well as outcome. The main finding is that those patients who were most lax in following the physician’s recommendations visited the emergency department twice as many times as those that had the highest adherence to the physician’s recommendations. (200)

Conclusion

John Norris 00:00, 20 February 2008 (CST)