Initial Development of a Computer Algorithm to Identify Patients With Breast and Lung Cancer Having Poor Prognosis in a Safety Net Hospital

Background: Physicians often have difficulty with prognostication and identification of patients who are in need of counseling about options for care at the end of life. Consequently, the objective of this study was to describe the initial stages in development of a computerized algorithm that will identify breast and lung cancer patients most in need of counseling about care options, including advance care planning, palliative care, and hospice. Methods: Clinical and non-clinical data were extracted from the electronic medical record of breast and lung cancer patients admitted to a large, urban hospital for the year 2010. These data were used to create an electronic (e-EOL) algorithm designed to identify advanced cancer patients who could benefit from in-depth discussion about end-of-life care options. Results: There were 369 eligible breast (42%) and lung (58%) cancer patients identified by ICD-9 code. The e-EOL algorithm identified 53 (14%) patients that met assigned criteria (presence of metastatic disease and albumin < 2.5 g/dl). The sensitivity, specificity, and positive predictive value of the first generation algorithm were 21%, 96%, and 91% when compared to physician expert chart review. Survival analysis showed that 6-month survival for algorithm positive cases was 46% versus 78% for algorithm negative cases, and 1-year survival was 32% versus 72%, respectively. Conclusions: Initial testing of the e-EOL algorithm appears to be promising. Other markers of advanced illness will added to the algorithm to improve its test operating characteristics so it may be used to identify patients with poor prognosis in real time.