Table 1.
Patient Characteristics and Information Extracted from Clinical Notes Between Patients with Hospitalization/ED Visit and those without (all P-value < 0.05).
| Patients with hospitalization /ED visits (n = 8379) | Patients without hospitalization /ED visits (n = 78,487) | |
|---|---|---|
|
| ||
| 1. Socio-demographic factor | ||
| Age, mean (SD) | 78.5 (12.8) | 78.9 (11.7) |
| Gender | ||
| Female [n, (%)] Ethnicity [n, (%)] | 5093 (60.8) | 50,448 (64.3) |
| Non-Hispanic White | 4750 (56.7) | 49,813 (63.5) |
| Non-Hispanic Black | 1825 (21.8) | 13,382 (17.0) |
| Hispanic | 1341 (16.0) | 10,459 (13.3) |
| Other | 463 (5.5) | 4833 (6.2) |
| Type of insurance [n, (%)] | ||
| Dual eligibility | 764 (9.1) | 4929 (6.3) |
| Medicare/Medicaid FFS only | 7556 (90.2) | 73,013 (93.0) |
| Any managed care | 50 (0.6) | 501 (0.6) |
| Other (e.g., private) | 9 (0.1) | 44 (0.1) |
| Living Condition [n, (%)] | ||
| Living with others (Congregate/Other) | 5304 (63.3) | 47,783 (60.9) |
| Living alone | 3075 (36.7) | 30,704 (39.1) |
| 2. Care related factor | ||
| Length of stay greater than 60 days [n, (%)] | 2708 (32.3) | 7940 (10.1) |
| 3. Medical conditions | ||
| Active Diagnoses [n, (%)] ** | ||
| Acute Myocardial Infarction | 1735 (20.7) | 14,041 (17.9) |
| Arthritis | 1188 (14.2) | 19,228 (24.5) |
| Cancer | 336 (4.0) | 1151 (1.5) |
| Cardiac Dysrhythmias | 1533 (18.3) | 11,796 (15.0) |
| Dementia | 1240 (14.8) | 10,154 (12.9) |
| Diabetes | 3175 (37.9) | 22,427 (28.6) |
| Heart Failure | 1946 (23.2) | 10,506 (13.4) |
| Pulmonary Disease | 1570 (18.7) | 11,638 (14.8) |
| Peripheral Vascular Disease | 358 (4.3) | 2459 (3.1) |
| Renal Disease | 686 (8.2) | 2567 (3.3) |
| Skin Ulcer | 1834 (21.9) | 9734 (12.4) |
| Stroke | 797 (9.5) | 6726 (8.6) |
| 4. Risk for Hospitalization [n, (%)] | ||
| History of falls in the past 12 months | 1856 (22.2) | 16,652 (21.2) |
| Multiple hospitalizations in the past 6 months | 3327 (39.7) | 18,328 (23.4) |
| Currently taking 5 or more medications | 7007 (83.6) | 13,186 (79.0) |
| 5. Sensory Status | ||
| Frequency of Pain [n, (%)] | ||
| Patient has no pain | 2199 (26.2) | 18,003 (22.9) |
| No Interference Activity or Less than Daily | 2219 (26.5) | 19,776 (25.2) |
| Daily, Not Constant, or All the Time | 3961 (47.3) | 40,708 (51.9) |
| 6. Integumentary [n, (%)] | ||
| Having a Risk of Developing Pressure Ulcers | 4187 (50.0) | 31,541 (40.2) |
| Having at least one Unhealed Pressure Ulcer at Stage II or Higher | 1116 (13.3) | 5377 (6.9) |
| Having Stasis Wound | 377 (4.5) | 2016 (2.6) |
| Having Surgical Wound | 1576 (18.8) | 21,500 (27.4) |
| Having a Skin Lesion or Open Wound | 2218 (26.5) | 15,761 (20.1) |
| 7. Respiratory Status | ||
| Short of Breath [n, (%)] | ||
| Never | 4112 (49.1) | 46,370 (59.1) |
| When walking more than 20 feet/climbing stairs | 3602 (43.0) | 29,028 (37.0) |
| With moderate/minimal exertion or at rest | 665 (7.9) | 3089 (3.9) |
| 8. Elimination | ||
| Urinary Tract Infection in the past 14 days [n, (%)] | 816 (9.7) | 5151 (6.6) |
| 9. Neuro, Emotional, and Behavioral Status | ||
| Cognitive Functioning [n, (%)] | ||
| Alert/oriented or prompting | 6987 (83.4) | 68,587 (87.4) |
| Requires assistance or totally dependent | 1392 (16.6) | 9900 (12.6) |
| When Confused [n, (%)] | ||
| Never | 3638 (43.4) | 40,550 (51.7) |
| In new or complex situations | 3571 (42.6) | 29,392 (37.4) |
| On awakening and/or at night only, or consistently | 1170 (14.0) | 8545 (10.9) |
| 10. ADLs / IADLs | ||
| ADL Needed [mean, (SD)] | 8.3 (1.4) | 8 (1.5) |
| ADL Severity [mean, (SD)] | 17.4 (7.7) | 15.5 (6.7) |
| 11. Risk Factors from Clinical Notes (Identified through NLP approaches) | ||
| Proportion of concerning notes (%) [mean, (SD)] | 30.9 (13.6) | 24.8 (13.4) |
| Omaha System Problem | ||
| Abuse [n, (%)] | 401 (4.8) | 1836 (2.3) |
| Bowel function [n, (%)] | 871 (10.4) | 3675 (4.7) |
| Circulation [n, (%)] | 3836 (45.8) | 26,890 (34.3) |
| Cognition [n, (%)] | 1931 (23.0) | 12,639 (16.1) |
| Infectious condition [n, (%)] | 3296 (39.3) | 19,300 (24.6) |
| Consciousness [n, (%)] | 616 (7.4) | 2053 (2.6) |
| Digestion/hydration [n, (%)] | 1193 (14.2) | 5870 (7.5) |
| Genitourinary function [n, (%)] | 532 (6.3) | 2236 (2.8) |
| Health care supervision [n, (%)] | 1000 (11.9) | 7088 (9.0) |
| Income [n, (%)] | 383 (4.6) | 2577 (3.3) |
| Interpersonal relationship [n, (%)] | 36 (0.4) | 150 (0.2) |
| Medication regimen [n, (%)] | 657 (7.8) | 4069 (5.2) |
| Mental health [n, (%)] | 3776 (45.1) | 24,870 (31.7) |
| Neglect [n, (%)] | 589 (7.0) | 2946 (3.8) |
| Neuro-musculo-skeletal | 4133 (49.4) | 36,073 (46.0) |
| function [n, (%)] | ||
| Nutrition [n, (%)] | 1251 (14.9) | 5986 (7.6) |
| Oral health [n, (%)] | 14 (0.2) | 63 (0.1) |
| Pain [n, (%)] | 4680 (55.9) | 37,446 (47.7) |
| Personal care [n, (%)] | 95 (1.1) | 331 (0.4) |
| Respiration [n, (%)] | 2979 (35.6) | 16,235 (20.7) |
| Skin [n, (%)] | 2786 (33.2) | 16,536 (21.1) |
| Social contact [n, (%)] | 1403 (16.8) | 14,738 (18.8) |
| Speech and language [n, (%)] | 547 (6.5) | 3283 (4.2) |
| Substance use [n, (%)] | 100 (1.2) | 459 (0.6) |
| Average number of problems per HHC episode [mean, (SD)] | 4.5 (2.7) | 3.2 (2.2) |