Clinical trial NCT03833804: Data-driven Identification for Substance Misuse
Official title: Data-driven Strategies for Substance Misuse Identification in Hospitalized Patients
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Substance Use
Substance Abuse
Substance-Related Disorders
Keywords: natural language processing
machine learning
artificial intelligence
clinical decision support
unhealthy alcohol use
opioid use disorder
illicit drug use
Lead sponsor: University of Wisconsin, Madison
Sponsor class: OTHER
Collaborators: name: Rush University Medical Center
name: National Institute on Drug Abuse (NIDA)
First posted: 2019-02-07
Enrollment: 64559
Sex: ALL
Minimum age (years): 18
Maximum age (years): 89
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Quasi-experimental design as an interrupted time series
Primary purpose: SCREENING

Brief summary: The investigators propose to develop an open-source, publicly available machine learning model that health systems could download and apply to their electronic health record data marts to screen for substance misuse in their patients. The investigators hypothesize that the natural language processing algorithm can provide a standardized and interoperable approach for an automated daily screen on all hospitalized patients and provide better implementation fidelity for screening, brief intervention, and referral to treatment.

Detailed description: In 2016, nearly 30% hospital discharges in the United States (US) had a major diagnostic category for a substance-use related condition. Substance misuse ranks second among principal diagnoses for unplanned 7-day hospital readmission rates. Despite the availability of Screening, Brief Intervention, and Referral to Treatment (SBIRT) interventions, substance misuse is not part of the admission routine and only a minority of patients are screened for substance misuse in the hospital setting. This is particularly problematic, since among hospitalized inpatients, the prevalence of substance misuse is estimated to be as high as 25%, greater than either the general population or outpatient setting. Practical screening methods tailored for the hospital setting are needed.

In the advent of Meaningful Use in the electronic health record (EHR), efficiency for alcohol detection may be improved by leveraging data collected during usual care. Documentation of substance use is common and occurs in over 96% of provider admission notes, but their free text format renders them difficult to mine and analyze. Natural Language Processing (NLP) and machine learning are subfields of artificial intelligence (AI) that provide a solution to analyze text data in the EHR to identify substance misuse. Modern NLP has fused with machine learning, another sub-field of artificial intelligence focused on learning from data. In particular, the most powerful NLP methods rely on supervised learning, a type of machine learning that takes advantage of current reference standards to make predictions about unseen cases

In the earlier version of an NLP and machine learning tool, the investigators successfully used data from clinical notes collected in the first 24 hours of hospital admission to reach a sensitivity and specificity above 70% for identifying alcohol misuse. With nearly 36 million hospital admissions in 2016, a substance misuse classifier has potential to impact millions.

In this study, the aim is to prospectively implement a substance misuse classifier to examine its effectiveness against current practice of all hospitalized adult patients at a tertiary health system. The health system has a mature screening system to examine substance misuse classifier performance against current practice of questionnaire screening.

The hypothesis is that the substance misuse classifier may provide a standardized, interoperable, and accurate approach to screen hospitalized patients. Successful implementation of the classifier in hospitalized patients is a step towards an automated and comprehensive universal screening system for substance misuse.

Eligibility criteria: Inclusion Criteria:

* Ages 18 years old to 89 years old
* Inpatient status during hospitalization
* Length of stay greater than 24 hours

Exclusion Criteria:

* Cannot participate in the usual care SBIRT intervention
* Death or obtunded during first 24 hours of admission
* Discharged against medical advice
* Transferred from another acute care hospital
* Transferred to another acute care hospital

Primary outcomes:
measure: Proportion of patients that had a universal screen positive and received SBIRT (screening, brief intervention, or referral to treatment)
timeFrame: 54 months
Secondary outcomes:
measure: All-cause re-hospitalizations following 6-months from the Index hospital encounter
timeFrame: 12 months enrollment with 6 months follow-up for rehospitalization
Other outcomes:
Locations:
city: Chicago
country: United States
facility: Rush University Medical Center
state: Illinois
Study officials:
References:
citation: Afshar M, Phillips A, Karnik N, Mueller J, To D, Gonzalez R, Price R, Cooper R, Joyce C, Dligach D. Natural language processing and machine learning to identify alcohol misuse from the electronic health record in trauma patients: development and internal validation. J Am Med Inform Assoc. 2019 Mar 1;26(3):254-261. doi: 10.1093/jamia/ocy166.