ArticleJMIR nursing2023
Home Health Care Clinicians' Use of Judgment Language for Black and Hispanic Patients: Natural Language Processing Study.
Article in JMIR nursing, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.
- The Perpetual Cycle of Racial Bias in Healthcare and Healthcare Education: A Systematic Review.Journal of racial and ethnic health disparities · 2026Pooled it
- Identifying and Reducing Stigmatizing Language in Home Health Care With a Natural Language Processing-Based System (ENGAGE): Protocol for a Mixed Methods Study.JMIR research protocols · 2025Article
- Beyond Keywords: A Qualitative Study of Context-Dependent Stigmatizing Language in Clinical Documentation from a Large, Multi-Payer Home Healthcare Agency.Home health care management & practice · 2025Article
- Risk Factors for Emergency Department Visits or Hospitalizations Among Older Adults With Urinary Incontinence in Home Health Care.Journal of gerontological nursing · 2025Article
- Racial bias in clinician assessment of patient credibility: Evidence from electronic health records.PloS one · 2025Article
- Race and Ethnicity Are Related to Undesirable Home Health Care Outcomes in Seriously Ill Older Adults.Journal of the American Medical Directors Association · 2024Article
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Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundA clinician's biased behavior toward patients can affect the quality of care. Recent literature reviews report on widespread implicit biases among clinicians. Although emerging studies in hospital settings show racial biases in the language used in clinical documentation within electronic health records, no studies have yet investigated the extent of judgment language in home health care.
objectiveWe aimed to examine racial differences in judgment language use and the relationship between judgment language use and the amount of time clinicians spent on home visits as a reflection of care quality in home health care.
methodsThis study is a retrospective observational cohort study. Study data were extracted from a large urban home health care organization in the Northeastern United States. Study data set included patients (N=45,384) who received home health care services between January 1 and December 31, 2019. The study applied a natural language processing algorithm to automatically detect the language of judgment in clinical notes.
resultsThe use of judgment language was observed in 38% (n=17,141) of the patients. The highest use of judgment language was found in Hispanic (7,167/66,282, 10.8% of all clinical notes), followed by Black (7,010/65,628, 10.7%), White (10,206/107,626, 9.5%), and Asian (1,756/22,548, 7.8%) patients. Black and Hispanic patients were 14% more likely to have notes with judgment language than White patients. The length of a home health care visit was reduced by 21 minutes when judgment language was used.
conclusionsRacial differences were identified in judgment language use. When judgment language is used, clinicians spend less time at patients' homes. Because the language clinicians use in documentation is associated with the time spent providing care, further research is needed to study the impact of using judgment language on quality of home health care. Policy, education, and clinical practice improvements are needed to address the biases behind judgment language.
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