{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T18:22:38Z","timestamp":1781288558770,"version":"3.54.1"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2018,6,27]],"date-time":"2018-06-27T00:00:00Z","timestamp":1530057600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/about_us\/legal\/notices"}],"funder":[{"name":"National Hartford Centers of Gerontological Nursing Excellence"},{"name":"NIH-NIA"},{"name":"African Americans Fighting Alzheimer\u2019s at Midlife","award":["R01 AG054059"],"award-info":[{"award-number":["R01 AG054059"]}]},{"name":"Wisconsin Alzheimer\u2019s Disease Center","award":["P50 AG033514"],"award-info":[{"award-number":["P50 AG033514"]}]},{"name":"NIH-NIA"},{"name":"Mentoring and Research in Patient-Oriented Geriatric Emergency Care","award":["K24AG054560-01"],"award-info":[{"award-number":["K24AG054560-01"]}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Despite increased risk for negative outcomes, cognitive impairment (CI) is greatly under-detected during hospitalization. While automated EHR-based phenotypes have potential to improve recognition of CI, they are hindered by widespread under-diagnosis of underlying etiologies such as dementia\u2014limiting the utility of more precise structured data elements. This study examined unstructured data on symptoms of CI in the acute-care EHRs of hip and stroke fracture patients with dementia from two hospitals. Clinician reviewers identified and classified unstructured EHR data using standardized criteria. Relevant narrative text was descriptively characterized and evaluated for key terminology. Most patient EHRs (90%) had narrative text reflecting cognitive and\/or behavioral dysfunction common in CI that were reliably classified (\u03ba 0.82). The majority of statements reflected vague descriptions of cognitive\/behavioral dysfunction as opposed to diagnostic terminology. Findings from this preliminary derivation study suggest that clinicians use specific terminology in unstructured EHR fields to describe common symptoms of CI. This terminology can inform the design of EHR-based phenotypes for CI and merits further investigation in more diverse, robustly characterized samples.<\/jats:p>","DOI":"10.1093\/jamia\/ocy070","type":"journal-article","created":{"date-parts":[[2018,5,15]],"date-time":"2018-05-15T20:48:07Z","timestamp":1526417287000},"page":"1206-1212","source":"Crossref","is-referenced-by-count":20,"title":["Unstructured clinical documentation reflecting cognitive and behavioral dysfunction: toward an EHR-based phenotype for cognitive impairment"],"prefix":"10.1093","volume":"25","author":[{"given":"Andrea L","family":"Gilmore-Bykovskyi","sequence":"first","affiliation":[{"name":"University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA"},{"name":"Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA"},{"name":"William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura M","family":"Block","sequence":"additional","affiliation":[{"name":"University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily","family":"Walljasper","sequence":"additional","affiliation":[{"name":"University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki","family":"Hill","sequence":"additional","affiliation":[{"name":"Penn State University College of Nursing, University Park, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carey","family":"Gleason","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA"},{"name":"William S. 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