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Pain Med. 2017 Oct 1;18(10):1952-1960. doi: 10.1093/pm/pnw283.

Enhancing Risk Assessment in Patients Receiving Chronic Opioid Analgesic Therapy Using Natural Language Processing.

Author information

1
Essentia Institute of Rural Health, Duluth, Minnesota.
2
North American Medical Affairs.
3
Statistics, Global Innovative Pharma.
4
Outcomes and Evidence, Global Health and Value, Pfizer Inc., New York, New York, USA.

Abstract

Objectives:

Clinical guidelines for the use of opioids in chronic noncancer pain recommend assessing risk for aberrant drug-related behaviors prior to initiating opioid therapy. Despite recent dramatic increases in prescription opioid misuse and abuse, use of screening tools by clinicians continues to be underutilized. This research evaluated natural language processing (NLP) together with other data extraction techniques for risk assessment of patients considered for opioid therapy as a means of predicting opioid abuse.

Design:

Using a retrospective cohort of 3,668 chronic noncancer pain patients with at least one opioid agreement between January 1, 2007, and December 31, 2012, we examined the availability of electronic health record structured and unstructured data to populate the Opioid Risk Tool (ORT) and other selected outcomes. Clinician-documented opioid agreement violations in the clinical notes were determined using NLP techniques followed by manual review of the notes.

Results:

Confirmed through manual review, the NLP algorithm had 96.1% sensitivity, 92.8% specificity, and 92.6% positive predictive value in identifying opioid agreement violation. At the time of most recent opioid agreement, automated ORT identified 42.8% of patients as at low risk, 28.2% as at moderate risk, and 29.0% as at high risk for opioid abuse. During a year following the agreement, 22.5% of patients had opioid agreement violations. Patients classified as high risk were three times more likely to violate opioid agreements compared with those with low/moderate risk.

Conclusion:

Our findings suggest that NLP techniques have potential utility to support clinicians in screening chronic noncancer pain patients considered for long-term opioid therapy.

KEYWORDS:

Chronic Pain; Electronic Health Records; Natural Language Processing; Opioid Analgesics; Risk Assessment

PMID:
28034982
DOI:
10.1093/pm/pnw283
[Indexed for MEDLINE]

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