Documentation of Screening for Firearm Access by Healthcare Providers in the Veterans Healthcare System: A Retrospective Study.
Adult
Cohort Studies
Cross-Sectional Studies
Delivery of Health Care
Documentation
Female
Firearms
/ statistics & numerical data
Health Personnel
/ psychology
Humans
Male
Mass Screening
/ organization & administration
Middle Aged
Research
Retrospective Studies
United States
Veterans
/ psychology
Suicide Prevention
Journal
The western journal of emergency medicine
ISSN: 1936-9018
Titre abrégé: West J Emerg Med
Pays: United States
ID NLM: 101476450
Informations de publication
Date de publication:
19 May 2021
19 May 2021
Historique:
received:
16
12
2020
accepted:
01
04
2021
entrez:
14
6
2021
pubmed:
15
6
2021
medline:
24
6
2021
Statut:
epublish
Résumé
Presence of a firearm is associated with increased risk of violence and suicide. United States military veterans are at disproportionate risk of suicide. Routine healthcare provider screening of firearm access may prompt counseling on safe storage and handling of firearms. The objective of this study was to determine the frequency with which Veterans Health Administration (VHA) healthcare providers document firearm access in electronic health record (EHR) clinical notes, and whether this varied by patient characteristics. The study sample is a post-9-11 cohort of veterans in their first year of VHA care, with at least one outpatient care visit between 2012-2017 (N = 762,953). Demographic data, veteran military service characteristics, and clinical comorbidities were obtained from VHA EHR. We extracted clinical notes for outpatient visits to primary, urgent, or emergency clinics (total 105,316,004). Natural language processing and machine learning (ML) approaches were used to identify documentation of firearm access. A taxonomy of firearm terms was identified and manually annotated with text anchored by these terms, and then trained the ML algorithm. The random-forest algorithm achieved 81.9% accuracy in identifying documentation of firearm access. The proportion of patients with EHR-documented access to one or more firearms during their first year of care in the VHA was relatively low and varied by patient characteristics. Men had significantly higher documentation of firearms than women (9.8% vs 7.1%; P < .001) and veterans >50 years old had the lowest (6.5%). Among veterans with any firearm term present, only 24.4% were classified as positive for access to a firearm (24.7% of men and 20.9% of women). Natural language processing can identify documentation of access to firearms in clinical notes with acceptable accuracy, but there is a need for investigation into facilitators and barriers for providers and veterans to improve a systemwide process of firearm access screening. Screening, regardless of race/ethnicity, gender, and age, provides additional opportunities to protect veterans from self-harm and violence.
Identifiants
pubmed: 34125022
pii: westjem.2021.4.51203
doi: 10.5811/westjem.2021.4.51203
pmc: PMC8203018
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
525-532Subventions
Organisme : HSRD VA
ID : IIR 18-035
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
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