{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:01:19Z","timestamp":1792191679991,"version":"4.4.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Despite its high prevalence and clinical impact, research on peripheral artery disease (PAD) remains limited due to poor accuracy of billing codes. Ankle-brachial index (ABI) and toe-brachial index can be used to identify PAD patients with high accuracy within electronic health records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We developed a novel natural language processing (NLP) algorithm for extracting ABI and toe-brachial index values and laterality (right or left) from ABI reports. A random sample of 800 reports from 94 Veterans Affairs facilities during 2015 to 2017 was selected and annotated by clinical experts. We trained the NLP system using random forest models and optimized it through sequential iterations of 10-fold cross-validation and error analysis on 600 test reports and evaluated its final performance on a separate set of 200 reports. We also assessed the accuracy of NLP-extracted ABI and toe-brachial index values for identifying patients with PAD in a separate cohort undergoing ABI testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The NLP system had an overall precision (positive predictive value) of 0.85, recall (sensitivity) of 0.93, and F1 measure (accuracy) of 0.89 to correctly identify ABI\/toe-brachial index values and laterality. Among 261 patients with ABI testing (49% PAD), the NLP system achieved a positive predictive value of 92.3%, sensitivity of 83.1%, and specificity of 93.1% to identify PAD when compared with a structured chart review. The above findings were consistent in a range of sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>We successfully developed and validated an NLP system for identifying patients with PAD within the Veterans Affairs electronic health record. Our findings have broad implications for PAD research and quality improvement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.121.011092","type":"journal-article","created":{"date-parts":[[2022,2,18]],"date-time":"2022-02-18T05:00:14Z","timestamp":1645160414000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Ankle- and Toe-Brachial Index for Peripheral Artery Disease Identification: Unlocking Clinical Data Through Novel Methods"],"prefix":"10.1161","volume":"15","author":[{"given":"Julia E.","family":"Friberg","sequence":"first","affiliation":[{"name":"Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (J.E.F., C.F., M.V.-S., B.C.L., S.G.), Department of Medicine, University of Iowa Carver College of Medicine, Iowa City."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul H.","family":"Qazi","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Massachusetts General Hospital, Boston (A.H.Q.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4403-2691","authenticated-orcid":true,"given":"Brenden","family":"Boyle","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Minnesota, Minneapolis (B.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie","family":"Franciscus","sequence":"additional","affiliation":[{"name":"Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (J.E.F., C.F., M.V.-S., B.C.L., S.G.), Department of Medicine, University of Iowa Carver College of Medicine, Iowa City."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8717-1061","authenticated-orcid":true,"given":"Mary","family":"Vaughan-Sarrazin","sequence":"additional","affiliation":[{"name":"Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center (J.E.F., C.F., M.V.-S., B.C.L., S.G.), Department of Medicine, University of Iowa Carver College of Medicine, Iowa City."},{"name":"General Internal Medicine (M.V.-S), Department of Medicine, University of Iowa Carver College of Medicine, Iowa City."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9547-7789","authenticated-orcid":true,"given":"Dax","family":"Westerman","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics (M.E.M, G.T.G, D.W.), Vanderbilt University Medical Center, Nashville, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8717-5975","authenticated-orcid":true,"given":"Olga V.","family":"Patterson","sequence":"additional","affiliation":[{"name":"Salt Lake City Veterans Affairs Medical Center, UT (O.V.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4596-3818","authenticated-orcid":true,"given":"Sharidan K.","family":"Parr","sequence":"additional","affiliation":[{"name":"Department of Medicine (M.E.M, S.K.P), Vanderbilt University Medical Center, Nashville, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3217-4147","authenticated-orcid":true,"given":"Michael E.","family":"Matheny","sequence":"additional","affiliation":[{"name":"Tennessee Valley Healthcare System, Nashville (M.E.M., G.T.G.)."},{"name":"Department of Biomedical Informatics (M.E.M, G.T.G, D.W.), Vanderbilt University Medical Center, Nashville, TN."},{"name":"Department of Medicine (M.E.M, S.K.P), Vanderbilt University Medical Center, Nashville, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0404-9325","authenticated-orcid":true,"given":"Shipra","family":"Arya","sequence":"additional","affiliation":[{"name":"Department of Surgery, Palo Alto Veterans Affairs Medical Center and Stanford University, CA (S.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6104-6254","authenticated-orcid":true,"given":"Kim G.","family":"Smolderen","sequence":"additional","affiliation":[{"name":"Department of Medicine and Psychiatry, Yale University School of Medicine, New Haven, CT (K.G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5191-728X","authenticated-orcid":true,"given":"Brian C.","family":"Lund","sequence":"additional","affiliation":[{"name":"Center for Access and Delivery 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