Table 5.

The top 3 association rules generated for the third 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 had between 24 and 49 COPDa diagnoses in the past year AND the patient had >11 nebulizer medication prescriptions in the past year AND the patient is Black or an African American→ the patient will probably have at least one severe COPD exacerbation in the following 12 months
	The patient had between 24 and 49 COPD diagnoses in the past year	Frequently receiving COPD diagnoses 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 had >11 nebulizer medication prescriptions in the past year	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 is a Black or an African American	Poor respiratory outcomes and low quality of life are more prevalent in Black and African American patients.	Ensure that the patient has needed resources and access to care Assess the need for social work or home care
Rank 2: The patient’s last EDb visit related to COPD occurred no less than 27.2 days ago and no more than 94.3 days ago AND the patient’s COPD medication prescriptions in the past year included between 13 and 16 distinct medications AND the patient’s last outpatient visit on COPD occurred no less than 82.4 days ago and no more than 327.6 days ago 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 last ED visit related to COPD occurred no less than 27.2 days ago and no more than 94.3 days ago	Having a recent ED visit related to COPD 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 medication prescriptions in the past year included between 13 and 16 distinct medications	Using many COPD medications can indicate an 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 using a pill organizer or providing reminders for taking medications in time Medication reconciliation review by a physician or a pharmacist
	The patient’s last outpatient visit on COPD occurred no less than 82.4 days ago and no more than 327.6 days ago	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
	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
Rank 3: The patient had between 8 and 19 diagnoses of acute COPD exacerbation in the past year AND the relative decline of the patient’s BMI in the past year was >0.44% AND the patient’s total length of inpatient stays in the past year was >0.6 day → 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 Ensure that the patient has a primary care provider or is referred to a specialist
	The relative decline of the patient’s BMI in the past year was >0.44%	Having an unintentional weight loss can indicate comorbidities or other complications, such as malnutrition or metabolic syndrome.	Optimize nutritional status to address low BMI Provide dietary education and advise appropriate exercise
	The patient’s total length of inpatient stays in the past year was >0.6 day	Having a long inpatient stay can indicate that the patient has a more severe disease or comorbidities. Having frequent inpatient stays shows a need for better control of the disease.	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

^aCOPD: chronic obstructive pulmonary disease.

^bED: emergency department.