In the US, ~24 million persons live with COPD, half undiagnosed, and ~150,000 die of COPD annually. COPD causes over 700,000 US hospitalizations and costs nearly $50 billion per year. The human and financial burdens of COPD could likely be reduced if disease progression and other adverse events could be anticipated, enabling caregivers to focus finite resources on at-risk patients. We propose to create a decision-support tool that integrates biomedical informatics with advanced machine learning (ML) and deep learning (DL) algorithms to predict acute and chronic healthcare encounters (hospital admissions, readmissions, and ED encounters) and major disease progression events (home oxygen therapy) for outpatients with COPD. Such a tool would confer immediate clinical benefits and accelerate research on COPD disease progression and treatment. Predictive modeling is widely used to identify high-risk patients for care management in COPD and other disorders, with a strong emphasis on readmission risk. However, extant techniques are not sufficiently accurate and do not identify the specific nature of likely future medical events, estimate time-to-event, and specifically forecast medical encounters and disease progression events for individuals with COPD. Recent research in disease progression modeling support the application of DL and other ML methods to electronic health records (EHRs) to predict aspects of health history. EHRs contain both readily accessible structured data (e.g., lab results in well-defined fields) and unstructured texts such as physician’s notes. Unstructured texts contain a great deal of clinical information, but this information is laborious to access; impeding its routine use in research and the clinic. This has motivated attempts to use natural language processing (NLP) methods to automate annotation. We will apply NLP to identify symptoms, treatments, procedures, diagnoses, social risk factors, and functional status from clinical notes, expanding the data available from EHRs far beyond the usual coded variables. Also, and distinctively, we will carry out a stepped-wedge clinical implementation of the proposed predictive tool and evaluate its performance, a first for ML and DL prediction of COPD health events. Therefore, we propose four Specific Aims: AIM 1: Transform EHR data streams to provision patient-level feature sets for ML and DL consumption. AIM 2: Develop a set of ML and DL models to predict the time-to-event for home oxygen therapy initiation and healthcare encounters among patients with COPD. AIM 3: To develop and implement a prospective performance surveillance and calibration maintenance system to maintain the final Aim 2 model for each outcome. AIM 4: Evaluate adoption and usability of the DeepCOPD toolkit in near-realtime clinical use in two healthcare systems. The application is responsive to the NHLBI IDEA2Health (NOT-HL-19-712).

Project Narrative The proposed program in chronic obstructive pulmonary disease (COPD) will provide actionable tools and information from health care data and machine learning to identify early and prevent COPD disease progression and major adverse health care encounters. The risk tools will be used in every day out-patient health care practice to help prevent disease progression requiring home oxygen use, major adverse health care encounters, and improve health care delivery for patients living with COPD in the community.