{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T01:26:06Z","timestamp":1774056366017,"version":"3.50.1"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T00:00:00Z","timestamp":1697500800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"National Institute on Aging; Amazon","award":["K99AG076808"],"award-info":[{"award-number":["K99AG076808"]}]},{"name":"National Institute on Aging; Amazon","award":["R01AG081928"],"award-info":[{"award-number":["R01AG081928"]}]},{"name":"Columbia University Center of AI Technology"},{"name":"Columbia University School of Nursing Pilot"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,18]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In the United States, over 12\u00a0000 home healthcare agencies annually serve 6+ million patients, mostly aged 65+ years with chronic conditions. One in three of these patients end up visiting emergency department (ED) or being hospitalized. Existing risk identification models based on electronic health record (EHR) data have suboptimal performance in detecting these high-risk patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To measure the added value of integrating audio-recorded home healthcare patient-nurse verbal communication into a risk identification model built on home healthcare EHR data and clinical notes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This pilot study was conducted at one of the largest not-for-profit home healthcare agencies in the United States. We audio-recorded 126 patient-nurse encounters for 47 patients, out of which 8 patients experienced ED visits and hospitalization. The risk model was developed and tested iteratively using: (1) structured data from the Outcome and Assessment Information Set, (2) clinical notes, and (3) verbal communication features. We used various natural language processing methods to model the communication between patients and nurses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Using a Support Vector Machine classifier, trained on the most informative features from OASIS, clinical notes, and verbal communication, we achieved an AUC-ROC\u2009=\u200999.68 and an F1-score\u2009=\u200994.12. By integrating verbal communication into the risk models, the F-1 score improved by 26%. The analysis revealed patients at high risk tended to interact more with risk-associated cues, exhibit more \u201csadness\u201d and \u201canxiety,\u201d and have extended periods of silence during conversation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This innovative study underscores the immense value of incorporating patient-nurse verbal communication in enhancing risk prediction models for hospitalizations and ED visits, suggesting the need for an evolved clinical workflow that integrates routine patient-nurse verbal communication recording into the medical record.<\/jats:p><\/jats:sec>","DOI":"10.1093\/jamia\/ocad195","type":"journal-article","created":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T20:26:30Z","timestamp":1697574390000},"page":"435-444","source":"Crossref","is-referenced-by-count":6,"title":["Utilizing patient-nurse verbal communication in building risk identification models: the missing critical data stream in home healthcare"],"prefix":"10.1093","volume":"31","author":[{"given":"Maryam","family":"Zolnoori","sequence":"first","affiliation":[{"name":"School of Nursing, Columbia University , New York, NY 10032, United States"},{"name":"Center for Home Care Policy & Research, VNS Health , New York, NY 10017, United States"}]},{"given":"Sridevi","family":"Sridharan","sequence":"additional","affiliation":[]},{"given":"Ali","family":"Zolnour","sequence":"additional","affiliation":[{"name":"School of Electrical and Computer Engineering, University of Tehran , Tehran 14395-515, Iran"}]},{"given":"Sasha","family":"Vergez","sequence":"additional","affiliation":[{"name":"Center for Home Care Policy & Research, VNS Health , New York, NY 10017, United States"}]},{"given":"Margaret V","family":"McDonald","sequence":"additional","affiliation":[{"name":"Center for Home Care Policy & Research, VNS Health , New York, NY 10017, United States"}]},{"given":"Zoran","family":"Kostic","sequence":"additional","affiliation":[{"name":"Electrical Engineering Department, Columbia University , New York, NY 10027, United States"}]},{"given":"Kathryn H","family":"Bowles","sequence":"additional","affiliation":[{"name":"Center for Home Care Policy & Research, VNS Health , New York, NY 10017, United States"},{"name":"School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, United States"}]},{"given":"Maxim","family":"Topaz","sequence":"additional","affiliation":[{"name":"School of Nursing, Columbia University , New York, NY 10032, United States"},{"name":"Center for Home Care Policy & Research, VNS Health , New York, NY 10017, United States"}]}],"member":"286","published-online":{"date-parts":[[2023,10,17]]},"reference":[{"issue":"2","key":"2024011907292106300_ocad195-B1","doi-asserted-by":"crossref","first-page":"e35325","DOI":"10.2196\/35325","article-title":"Audio recording patient-nurse verbal communications in home health care settings: pilot feasibility and usability study","volume":"9","author":"Zolnoori","year":"2022","journal-title":"JMIR Hum Factors"},{"issue":"2","key":"2024011907292106300_ocad195-B2","doi-asserted-by":"crossref","first-page":"ooac034","DOI":"10.1093\/jamiaopen\/ooac034","article-title":"Do nurses document all discussions of patient problems and nursing interventions in the electronic health record? 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