Table 3.

The top 3 association rules generated for the first example patient.

Rank, rule, and item on the rule’s left-hand side		Interpretation of the item	Interventions linked to the item
Rank 1: The patient’s last diagnosis of acute COPDa exacerbation was from the past 81.4 days AND the patient’s COPD reliever prescriptions in the past year included >10 distinct medications → the patient will probably have at least one severe COPD exacerbation in the following 12 months
	The patient’s last diagnosis of acute COPD exacerbation was from the past 81.4 days	Having a recent acute COPD exacerbation shows a need for better control of the disease.	Provide education on managing COPD and more frequent follow-ups Ensure use of appropriate COPD medications Consider influenza shot, pneumonia vaccination, or smoking cessation Assess the need for pulmonary rehabilitation or home care Ensure that the patient has a primary care provider or is referred to a specialist
	The patient’s COPD reliever prescriptions in the past year included >10 distinct medications	Using many rescue medications for COPD indicates ineffective regimen, poor treatment adherence, or poor control of the disease.	Simplify COPD medications to once-a-day formulations or combination medications Address concerns for adverse interactions between medications Provide education on the correct use of COPD medications or inhalers Consider strategies to improve medication adherence such as providing reminders for taking medications in time Medication reconciliation review by a physician or a pharmacist
Rank 2: The patient had between 8 and 19 diagnoses of acute COPD exacerbation in the past year AND the patient’s last COPD diagnosis was from the past 25.6 days AND the patient’s nebulizer medication prescriptions in the past year included >11 medications → the patient will probably have at least one severe COPD exacerbation in the following 12 months
	The patient had between 8 and 19 diagnoses of acute COPD exacerbation in the past year	Frequently having acute COPD exacerbations shows a need for better control of the disease.	Provide education on managing COPD and more frequent follow-ups Ensure use of appropriate COPD medications Consider influenza shot, pneumonia vaccination, or smoking cessation Assess the need for pulmonary rehabilitation or home care
	The patient’s last COPD diagnosis was from the past 25.6 days	Having a recent COPD diagnosis associated with an EDb visit or an inpatient stay indicates poor control of the disease.	Provide education on managing COPD and more frequent follow-ups Ensure use of appropriate COPD medications Consider influenza shot, pneumonia vaccination, or smoking cessation Assess the need for pulmonary rehabilitation or home care
	The patient’s nebulizer medication prescriptions in the past year included >11 medications	Using many medications for COPD with a nebulizer indicates an ineffective regimen, poor treatment adherence, or poor control of the disease. Using nebulizer medications could be a sign of having a mild exacerbation or more severe COPD.	Simplify COPD medications to once-a-day formulations or combination medications Address concerns for adverse interactions between medications Provide education on the correct use of COPD medications or inhalers Consider strategies to improve medication adherence such as providing reminders for taking medications in time Medication reconciliation review by a physician or a pharmacist
Rank 3: The patient’s average length of an inpatient stay in the past year was between 0.61 and 7.66 days AND the patient’s last outpatient visit on COPD occurred in the past 82.4 days AND the patient’s nebulizer medication prescriptions in the past year included >11 medications AND the patient’s maximum percentage of neutrophils in the past year was >76.5% → the patient will probably have at least one severe COPD exacerbation in the following 12 months
	The patient’s average length of an inpatient stay in the past year was between 0.61 and 7.66 days	Having a long inpatient stay can indicate that the patient has a more severe disease or comorbidities.	Ensure that the patient has a primary care provider Assess the need for home care or referral to a skilled nursing facility Provide education on managing COPD and resources for care Ensure use of appropriate COPD medications
	The patient’s last outpatient visit on COPD occurred in the past 82.4 days	If the patient’s last outpatient visit on COPD was for acute problems with COPD, it could indicate poor control of the disease and a need for additional support to control COPD.	Provide education on managing COPD and resources for care Ensure use of appropriate COPD medications Assess the need for home care or pulmonary rehabilitation
	The patient’s nebulizer medication prescriptions in the past year included >11 medications	Using many medications for COPD with a nebulizer indicates an ineffective regimen, poor treatment adherence, or poor control of the disease. Using nebulizer medications could be a sign of having a mild exacerbation or more severe COPD.	Simplify COPD medications to once-a-day formulations or combination medications Address concerns for adverse interactions between medications Provide education on the correct use of COPD medications or inhalers Consider strategies to improve medication adherence such as providing reminders for taking medications in time Medication reconciliation review by a physician or a pharmacist
	The patient’s maximum percentage of neutrophils in the past year was >76.5%	Having a large percentage of neutrophils can indicate infections or distress.	Evaluate the respiratory system, for example, using radiographic imaging Consider doing diagnostic tests such as viral panel, sputum culture, or procalcitonin Evaluate other potential morbidities such as cardiovascular disease with an electrocardiogram, echocardiography, or laboratory tests such as brain natriuretic peptide or D-dimer

^aCOPD: chronic obstructive pulmonary disease.

^bED: emergency department.