A few groups of VA researchers are using artificial intelligence (AI) to identify Veterans at high risk of hospitalization or death. That can help ensure these Veterans get the best care possible.
One potential approach was described in a recent article in the journal PLOS ONE. The research pinpointed subgroups of high-risk Veterans. The idea was to match patients with the right types of care, explains the study’s lead author, VA cancer physician and investigator Dr. Ravi Parikh.
Dr. Ravi Parikh is a cancer doctor with expertise in informatics and health care delivery. Among other areas, he studies the use of health technology—such as artificial intelligence—to improve routine patient care. (Photo by Sam Shavers)
His colleague, lead investigator Dr. Amol Navathe, a VA internal medicine physician and health economist, said, “Not only can this understanding of high-risk subgroups help doctors connect their patients with appropriate care strategies, but the knowledge can also support the development of improved VA care programs and strategies to target Veterans’ individual needs.”
Building on established tools
The team looked at the records of Veterans already identified as high-risk by VA’s sophisticated Care Assessment Needs (CAN) calculator. The CAN tool provides a score reflecting a Veteran’s risk of hospitalization or death within a year.
“VA has long been on the forefront of using predictive analytics to improve patient care,” said Navathe, who works at VA’s Corporal Michael J. Crescenz VA Medical Center in Philadelphia and the University of Pennsylvania. “High-performing tools such as CAN are already used routinely in VA to estimate risk and ensure that highest-need Veterans are receiving beneficial interventions.”
The researchers wanted to take the information from CAN a step further, explained Parikh. He is an investigator with VA’s Center for Health Equity Research and Promotion (CHERP) and a cancer physician who, like Navathe, works at both the Philadelphia VA and the University of Pennsylvania.
“A Veteran might be in the 85th percentile in terms of health risk, but we examined why they were at such high risk, so VA care providers could identify effective targeted care strategies,” Parikh said.
`An outstanding electronic health record system’
The study focused on 110,000 Veterans that CAN placed in the top 25% risk-wise. The team sought common traits among them, using data from VA’s advanced electronic health record system.
“We have an outstanding electronic health record system that includes granular details, down to cholesterol levels and blood pressure readings,” Navathe said.
Many additional features known to influence care and outcomes are also documented in the records. These include demographic features such as race and ethnicity, psychobehavioral factors like drug and alcohol use, and social restrictions like transportation limitations and inadequate housing that could impact access and care.
Machine learning identifies subgroups
The team used a type of AI called machine learning to “read” through the records. With machine learning, computers imitate human intelligence, solving complex problems that often involve huge amounts of data. Medical record reviews with machine learning can identify patterns beyond the reach of a doctor’s traditional—and time-consuming—chart reviews.
The approach can “boil down immense amounts of information into a sort of CliffsNotes version,” Navathe explained.
The AI categorized data into 119 variables relating to Veterans’ medical conditions, demographics, vital signs, lab results, and other features. From there, the researchers identified 30 distinct subgroups of high-health risk Veterans. Of these, 21 subgroups related to medical conditions, such as kidney or liver disease and insulin-dependent diabetes. The remaining subgroups—relating to factors like gender, ethnicity, Medicaid coverage, or substance use—were not directly related to health conditions.
The aim is to be able to tell VA health care providers, “This patient is at high risk, and here is the subgroup he or she belongs to.” The information would also help the provider connect a high-risk patient to the right therapies and supportive care.
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An AI review of a human’s health records is equivalent to a paparazzo getting to be the deciding factor in the care of an ill movie star. Hearsay, which is what medical “practitioners'” recorded impressions ultimately amount to, should not be the basis of the level of care a person receives. This AI-assisted system has a high probability of doctors’ implicit biases remaining, sadly, the deciding factor in the quality of care “other” veterans receive. The addition of gender, race, age, and any “other”-distinguishing trait is a minus, not a plus when it comes to military medical care.