Computational Barthel Index: An Automated Tool for Assessing and Predicting Activities of Daily Living Among Nursing Home Patients
Background: Assessment of functional ability, including Activities of Daily Living (ADLs), is a manual process completed by skilled health professionals. We investigated the possibility of constructing an automated decision support tool, the Computational Barthel Index Tool (CBIT), that automatically assesses and predicts probabilities of current and future ADLs based on patients' medical history. Methods: The data used to construct the tool include the demographic information, diagnosis codes,
... n, diagnosis codes, and reported disabilities of 181,213 residents of the Department of Veterans Affairs' (VA) Community Living Centers. Supervised machine learning methods were applied to construct the CBIT. Temporal information about times from the first and the most recent occurrence of diagnoses was encoded. Ten-fold cross-validation was used to tune hyperparameters, and independent test sets were used to evaluate models using AUC, accuracy, recall, and precision. Random forest achieved the best model quality. Models were calibrated using isonomic regression. Results: The unabridged version of CBIT uses 578 patient characteristics and achieved average AUC of 0.94 (0.93-0.95), accuracy of 0.90 (0.89-0.91), precision of 0.91 (0.89-0.92), and recall of 0.90 (0.84-0.95) when re-evaluating patients. CBIT is also capable of predicting ADLs up to one year ahead, with accuracy decreasing over time, giving average AUC of 0.77 (0.73-0.79), accuracy of 0.73 (0.69-0.80), precision of 0.74 (0.66-0.81), and recall of 0.69 (0.34-0.96). A simplified version of CBIT with 50 top patient characteristics reached performance that does not significantly differ from full CBIT.Conclusion: Discharge planners, disability application reviewers, clinicians evaluating comparative effectiveness of treatments can use CBIT to assess and predict information on functional status of patients.