Postdischarge Communication Between Home Health Nurses and Physicians: Measurement, Quality, and Outcomes.
OBJECTIVES
To use natural language processing (NLP) of text from electronic medical records (EMRs) to identify failed communication attempts between home health nurses and physicians, to identify predictors of communication failure, and to assess the association between communication failure and hospital readmission.


DESIGN
Retrospective cohort study.


SETTING
Visiting Nurse Service of New York (VNSNY), the nation's largest freestanding home health agency.


PARTICIPANTS
Medicare beneficiaries with congestive heart failure who received home health care from VNSNY after hospital discharge in 2008-09 (N = 5,698).


MEASUREMENTS
Patient-level measures of communication failure and risk-adjusted 30-day all-cause readmission.


RESULTS
Identification of failed communication attempts using NLP had high external validity (kappa = 0.850, P < .001). A mean of 8% of communication attempts failed per episode of home care; failure rates were higher for black patients and lower for patients from higher median income ZIP codes. The association between communication failure and readmission was not significant with adjustment for patient, nurse, physician, and hospital factors.


CONCLUSION
NLP of EMRs can be used to identify failed communication attempts between home health nurses and physicians, but other variables mostly explained the association between communication failure and readmission. Communication failures may contribute to readmissions in more-serious clinical situations, an association that this study may have been underpowered to detect.
['Press|Matthew J|MJ|', 'Gerber|Linda M|LM|', 'Peng|Timothy R|TR|', 'Pesko|Michael F|MF|', 'Feldman|Penny H|PH|', 'Ouchida|Karin|K|', 'Sridharan|Sridevi|S|', 'Bao|Yuhua|Y|', 'Barron|Yolanda|Y|', 'Casalino|Lawrence P|LP|']
D000369:Aged, 80 and over D000465:Algorithms D057286:Electronic Health Records D005260:Female D006333:Heart Failure D006801:Humans D033183:Interdisciplinary Communication D008297:Male D006278:Medicare D009323:Natural Language Processing D009518:New York D064691:Nurses, Community Health D010820:Physicians D011785:Quality Assurance, Health Care D012189:Retrospective Studies D016896:Treatment Outcome D014481:United States
natural language processing readmission home health care care coordination