Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 23;8(1):2004664.
doi: 10.1080/20018525.2021.2004664. eCollection 2021.

Documentation of the patient's smoking status in common chronic diseases - analysis of medical narrative reports using the ULMFiT based text classification

Eveliina Hirvonen  1   2 , Antti Karlsson  3 , Tarja Saaresranta  1   2 , Tarja Laitinen  1   4
Affiliations

Documentation of the patient's smoking status in common chronic diseases - analysis of medical narrative reports using the ULMFiT based text classification

Eveliina Hirvonen et al. Eur Clin Respir J. .

Abstract

Introduction: Smoking cessation is essential part of a successful treatment in many chronic diseases. Our aim was to analyse how actively clinicians discuss and document patients' smoking status into electronic health records (EHR) and deliver smoking cessation assistance.

Methods: We analysed the results using a combination of rule and deep learning-based algorithms. Narrative reports of all adult patients, whose treatment started between years 2010 and 2016 for one of seven common chronic diseases, were followed for two years. Smoking related sentences were first extracted with a rule-based algorithm. Subsequently, pre-trained ULMFiT-based algorithm classified each patient's smoking status as a current smoker, ex-smoker, or never smoker. A rule-based algorithm was then again used to analyse the physician-patient discussions on smoking cessation among current smokers.

Results: A total of 35,650 patients were studied. Of all patients, 60% were found to have a smoking status in EHR and the documentation improved over time. Smoking status was documented more actively among COPD (86%) and sleep apnoea (83%) patients compared to patients with asthma, type 1&2 diabetes, cerebral infarction and ischemic heart disease (range 44-61%). Of the current smokers (N=7,105), 49% had discussed smoking cessation with their physician. The performance of ULMFiT-based classifier was good with F-scores 79-92.

Conclusion: Ee found that smoking status was documented in 60% of patients with chronic disease and that the clinician had discussed smoking cessation in 49% of patients who were current smokers. ULMFiT-based classifier showed good/excellent performance and allowed us to efficiently study a large number of patients' medical narratives.

Keywords: Smoking; ULMFiT; artificial intelligence; deep learning; electronic health records; language modelling; machine learning; medical narrative; natural language processing; smoking cessation; smoking intervention; transfer learning.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure1.
Figure1.
Percentage of patients with at least one documented smoking status during a two-year follow-up
See this image and copyright information in PMC

References

    1. World Health Organization . WHO REPORT On The Global Tobacco Epidemic, 2015 raising taxes on tobacco. 2015. [cited 2017 Jan 22]; Available from: https://www.who.int/health-topics/tobacco
    1. Virtanen S, Jääskeläinen M.. Tobacco statistics 2018. 2019; Available from: http://urn.fi/URN:NBN:fi-fe2019121046603
    1. US Department of Health and Human Services . Smoking Cessation: A Report of the Surgeon General. Atlanta, GA; 2020.
    1. Maddatu J, Anderson-Baucum E, Evans-Molina C. Smoking and the risk of type 2 diabetes [Internet]. Vol. 184, Translational Research. Mosby Inc.; 2017. [cited 2020 Oct 22]. p. 101–7. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.utu.fi/28336465/ - PMC - PubMed
    1. Keto J, Jokelainen J, Timonen M, et al. Physicians discuss the risks of smoking with their patients, but seldom offer practical cessation support. Subst Abuse Treat Prev Policy [Internet]. 2015. Dec 2 [cited 2019 Sep 17];10(1):43. Available from:: http://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-01... - DOI - PMC - PubMed

LinkOut - more resources