Measuring quality-of-care in treatment of young children with attention-deficit/hyperactivity disorder using pre-trained language models

Author:

Pillai Malvika1ORCID,Posada Jose2,Gardner Rebecca M3,Hernandez-Boussard Tina1ORCID,Bannett Yair4ORCID

Affiliation:

1. Department of Biomedical Data Science, Stanford University School of Medicine , Stanford, CA 94305, United States

2. Computer Science Department, University of the North , Barranquilla 080020, Colombia

3. Department of Epidemiology and Population Health, Stanford University School of Medicine , Stanford, CA 94305, United States

4. Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine , Stanford, CA 94304, United States

Abstract

Abstract Objective To measure pediatrician adherence to evidence-based guidelines in the treatment of young children with attention-deficit/hyperactivity disorder (ADHD) in a diverse healthcare system using natural language processing (NLP) techniques. Materials and Methods We extracted structured and free-text data from electronic health records (EHRs) of all office visits (2015-2019) of children aged 4-6 years in a community-based primary healthcare network in California, who had ≥1 visits with an ICD-10 diagnosis of ADHD. Two pediatricians annotated clinical notes of the first ADHD visit for 423 patients. Inter-annotator agreement (IAA) was assessed for the recommendation for the first-line behavioral treatment (F-measure = 0.89). Four pre-trained language models, including BioClinical Bidirectional Encoder Representations from Transformers (BioClinicalBERT), were used to identify behavioral treatment recommendations using a 70/30 train/test split. For temporal validation, we deployed BioClinicalBERT on 1,020 unannotated notes from other ADHD visits and well-care visits; all positively classified notes (n = 53) and 5% of negatively classified notes (n = 50) were manually reviewed. Results Of 423 patients, 313 (74%) were male; 298 (70%) were privately insured; 138 (33%) were White; 61 (14%) were Hispanic. The BioClinicalBERT model trained on the first ADHD visits achieved F1 = 0.76, precision = 0.81, recall = 0.72, and AUC = 0.81 [0.72-0.89]. Temporal validation achieved F1 = 0.77, precision = 0.68, and recall = 0.88. Fairness analysis revealed low model performance in publicly insured patients (F1 = 0.53). Conclusion Deploying pre-trained language models on a variable set of clinical notes accurately captured pediatrician adherence to guidelines in the treatment of children with ADHD. Validating this approach in other patient populations is needed to achieve equitable measurement of quality of care at scale and improve clinical care for mental health conditions.

Funder

Stanford Maternal and Child Health Research Institute

National Institute of Mental Health

National Institutes of Health

Advanced Data and Analytics for Behavioral and Social Sciences Research

NIH

National Heart, Lung, and Blood Institute

Publisher

Oxford University Press (OUP)

Reference40 articles.

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