Evidence map›Paper›PMID 38858343›Full record

ArticleJournal of general internal medicine2024

Equity in Using Artificial Intelligence Mortality Predictions to Target Goals of Care Documentation.

Gina M Piscitello, Shari Rogal, Jane Schell, Yael Schenker, Robert M Arnold

Abstract read
In one paragraph

Article in Journal of general internal medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Gina M PiscitelloDivision of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA, USA. ginapiscitello@pitt.edu.ORCID 0000-0002-3958-4491
Shari RogalDepartments of Medicine and Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Jane SchellDivision of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA, USA.
Yael SchenkerDivision of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA, USA.
Robert M ArnoldDepartment of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Funding

NRSA Training CoreTL1TR001858 · NCATS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI RADOMSKI, THOMAS, RUBIO, DORIS M · 2016 to 2025
$11.1M
Midcareer Investigator Award in Patient-Oriented Research: Yael Schenker, MD, MASK24AG070285 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI SCHENKER, YAEL · 2021 to 2025
$841k
Improving Pain Management and Opioid Safety for Patients with CirrhosisK23DA048182 · NIDA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI ROGAL, SHARI S · 2020 to 2023
$755k
NCATS NIH HHS TL1 TR001858NIA NIH HHS K24 AG070285NIDA NIH HHS K23 DA048182NIH HHS 5TL1TR001858-07NIH HHS K23DA048182NIH HHS K24AG070285
6 · The paper itself

Abstract

backgroundArtificial intelligence (AI) algorithms are increasingly used to target patients with elevated mortality risk scores for goals-of-care (GOC) conversations.

objectiveTo evaluate the association between the presence or absence of AI-generated mortality risk scores with GOC documentation.

designRetrospective cross-sectional study at one large academic medical center between July 2021 and December 2022.

participantsHospitalized adult patients with AI-defined Serious Illness Risk Indicator (SIRI) scores indicating > 30% 90-day mortality risk (defined as "elevated" SIRI) or no SIRI scores due to insufficient data.

interventionA targeted intervention to increase GOC documentation for patients with AI-generated scores predicting elevated risk of mortality. MAIN MEASURES: Odds ratios comparing GOC documentation for patients with elevated or no SIRI scores with similar severity of illness using propensity score matching and risk-adjusted mixed-effects logistic regression. KEY

resultsAmong 13,710 patients with elevated (n = 3643, 27%) or no (n = 10,067, 73%) SIRI scores, the median age was 64 years (SD 18). Twenty-five percent were non-White, 18% had Medicaid, 43% were admitted to an intensive care unit, and 11% died during admission. Patients lacking SIRI scores were more likely to be younger (median 60 vs. 72 years, p < 0.0001), be non-White (29% vs. 13%, p < 0.0001), and have Medicaid (22% vs. 9%, p < 0.0001). Patients with elevated versus no SIRI scores were more likely to have GOC documentation in the unmatched (aOR 2.5, p < 0.0001) and propensity-matched cohorts (aOR 2.1, p < 0.0001).

conclusionsUsing AI predictions of mortality to target GOC documentation may create differences in documentation prevalence between patients with and without AI mortality prediction scores with similar severity of illness. These finding suggest using AI to target GOC documentation may have the unintended consequence of disadvantaging severely ill patients lacking AI-generated scores from receiving targeted GOC documentation, including patients who are more likely to be non-White and have Medicaid insurance.

Indexed as

Artificial IntelligenceAdultAgedAged, 80 and overCross-Sectional StudiesDocumentationFemaleHospital MortalityHumansMaleMiddle AgedPatient Care PlanningRetrospective StudiesRisk Assessment

Identifiers

PMID38858343
PMCPMC11576666

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.