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Subtypes in patients with opioid misuse: A prognostic enrichment strategy using electronic health record data in hospitalized patients

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Listed:
  • Majid Afshar
  • Cara Joyce
  • Dmitriy Dligach
  • Brihat Sharma
  • Robert Kania
  • Meng Xie
  • Kristin Swope
  • Elizabeth Salisbury-Afshar
  • Niranjan S Karnik

Abstract

Background: Approaches are needed to better delineate the continuum of opioid misuse that occurs in hospitalized patients. A prognostic enrichment strategy with latent class analysis (LCA) may facilitate treatment strategies in subtypes of opioid misuse. We aim to identify subtypes of patients with opioid misuse and examine the distinctions between the subtypes by examining patient characteristics, topic models from clinical notes, and clinical outcomes. Methods: This was an observational study of inpatient hospitalizations at a tertiary care center between 2007 and 2017. Patients with opioid misuse were identified using an operational definition applied to all inpatient encounters. LCA with eight class-defining variables from the electronic health record (EHR) was applied to identify subtypes in the cohort of patients with opioid misuse. Comparisons between subtypes were made using the following approaches: (1) descriptive statistics on patient characteristics and healthcare utilization using EHR data and census-level data; (2) topic models with natural language processing (NLP) from clinical notes; (3) association with hospital outcomes. Findings: The analysis cohort was 6,224 (2.7% of all hospitalizations) patient encounters with opioid misuse with a data corpus of 422,147 clinical notes. LCA identified four subtypes with differing patient characteristics, topics from the clinical notes, and hospital outcomes. Class 1 was categorized by high hospital utilization with known opioid-related conditions (36.5%); Class 2 included patients with illicit use, low socioeconomic status, and psychoses (12.8%); Class 3 contained patients with alcohol use disorders with complications (39.2%); and class 4 consisted of those with low hospital utilization and incidental opioid misuse (11.5%). The following hospital outcomes were the highest for each subtype when compared against the other subtypes: readmission for class 1 (13.9% vs. 10.5%, p

Suggested Citation

  • Majid Afshar & Cara Joyce & Dmitriy Dligach & Brihat Sharma & Robert Kania & Meng Xie & Kristin Swope & Elizabeth Salisbury-Afshar & Niranjan S Karnik, 2019. "Subtypes in patients with opioid misuse: A prognostic enrichment strategy using electronic health record data in hospitalized patients," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-18, July.
    • Handle: RePEc:plo:pone00:0219717
    DOI: 10.1371/journal.pone.0219717
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    1. Krieger, N. & Waterman, P.D. & Spasojevic, J. & Li, W. & Maduro, G. & Van Wye, G., 2016. "Public health monitoring of privilege and deprivation with the index of concentration at the extremes," American Journal of Public Health, American Public Health Association, vol. 106(2), pages 256-263.
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