Does synthetic data augmentation improve the performances of machine learning classifiers for identifying health problems in patient-nurse verbal communications in home healthcare settings?

BACKGROUND: Identifying health problems in audio-recorded patient-nurse communication is important to improve outcomes in home healthcare patients who have complex conditions with increased risks of hospital utilization. Training machine learning classifiers for identifying problems requires resource-intensive human annotation. OBJECTIVE: To generate synthetic patient-nurse communication and to automatically annotate for common health problems encountered in home healthcare settings using GPT-4. We also examined whether augmenting real-world patient-nurse communication with synthetic data can improve the performance of machine learning to identify health problems. DESIGN: Secondary data analysis of patient-nurse verbal communication data in home healthcare settings. METHODS: The data were collected from one of the largest home healthcare organizations in the United States. We used 23 audio recordings of patient-nurse communications from 15 patients. The audio recordings were transcribed verbatim and manually annotated for health problems (e.g., circulation, skin, pain) indicated in the Omaha System Classification scheme. Synthetic data of patient-nurse communication were generated using the in-context learning prompting method, enhanced by chain-of-thought prompting to improve the automatic annotation performance. Machine learning classifiers were applied to three training datasets: real-world communication, synthetic communication, and real-world communication augmented by synthetic communication. RESULTS: Average F1 scores improved from 0.62 to 0.63 after training data were augmented with synthetic communication. The largest increase was observed using the XGBoost classifier where F1 scores improved from 0.61 to 0.64 (about 5% improvement). When trained solely on either real-world communication or synthetic communication, the classifiers showed comparable F1 scores of 0.62-0.61, respectively. CONCLUSION: Integrating synthetic data improves machine learning classifiers' ability to identify health problems in home healthcare, with performance comparable to training on real-world data alone, highlighting the potential of synthetic data in healthcare analytics. CLINICAL RELEVANCE: This study demonstrates the clinical relevance of leveraging synthetic patient-nurse communication data to enhance machine learning classifier performances to identify health problems in home healthcare settings, which will contribute to more accurate and efficient problem identification and detection of home healthcare patients with complex health conditions.

Utilizing patient-nurse verbal communication in building risk identification models: the missing critical data stream in home healthcare.

BACKGROUND: In the United States, over 12 000 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. OBJECTIVES: 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. METHODS: 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. RESULTS: Using a Support Vector Machine classifier, trained on the most informative features from OASIS, clinical notes, and verbal communication, we achieved an AUC-ROC = 99.68 and an F1-score = 94.12. 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 "sadness" and "anxiety," and have extended periods of silence during conversation. CONCLUSION: 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.

Is the patient speaking or the nurse? Automatic speaker type identification in patient-nurse audio recordings.

OBJECTIVES: Patient-clinician communication provides valuable explicit and implicit information that may indicate adverse medical conditions and outcomes. However, practical and analytical approaches for audio-recording and analyzing this data stream remain underexplored. This study aimed to 1) analyze patients' and nurses' speech in audio-recorded verbal communication, and 2) develop machine learning (ML) classifiers to effectively differentiate between patient and nurse language. MATERIALS AND METHODS: Pilot studies were conducted at VNS Health, the largest not-for-profit home healthcare agency in the United States, to optimize audio-recording patient-nurse interactions. We recorded and transcribed 46 interactions, resulting in 3494 "utterances" that were annotated to identify the speaker. We employed natural language processing techniques to generate linguistic features and built various ML classifiers to distinguish between patient and nurse language at both individual and encounter levels. RESULTS: A support vector machine classifier trained on selected linguistic features from term frequency-inverse document frequency, Linguistic Inquiry and Word Count, Word2Vec, and Medical Concepts in the Unified Medical Language System achieved the highest performance with an AUC-ROC = 99.01 ± 1.97 and an F1-score = 96.82 ± 4.1. The analysis revealed patients' tendency to use informal language and keywords related to "religion," "home," and "money," while nurses utilized more complex sentences focusing on health-related matters and medical issues and were more likely to ask questions. CONCLUSION: The methods and analytical approach we developed to differentiate patient and nurse language is an important precursor for downstream tasks that aim to analyze patient speech to identify patients at risk of disease and negative health outcomes.