Dissertation/Thesis Abstract

Clinical Decision Support System for the Diagnosis, Analysis and Management of Hepatitis C
by Tandon, Pratima, D.P.H., Rutgers The State University of New Jersey, Rutgers School of Health Professions, 2020, 293; 28091759
Abstract (Summary)

Diagnosing, analyzing and managing hepatitis C is an important task for physicians. Traditional diagnosis of chronic disease, like Hepatitis C, is time consuming and expensive. In order to understand the complete analysis of Hepatitis, an understanding of the overall impact of Hepatitis C Length of Stay in the hospital, total charges of the treatment, procedures, mortality rate, morbidity and how Hepatitis effects the liver so that an early diagnose of Hepatitis C Virus must be achieved. The research is divided into two parts, first part is data analysis of hepatitis and liver diseases, and the second part is Clinical Decision Support System (CDSS) for the diagnosis of Hepatitis C is proposed.

The objective of this study is to examine the hospitalization outcomes of total charges, length of stay in the hospital, cost of the treatment, died during hospitalization, procedures, for gender, race/ethnicity, Insurance type, income level, location of the hospital, age, region of the hospital, destination after discharge, admission source, mortality, morbidity, and admission to the hospital. The study focusses on the facts about the Hepatitis C and other Liver Diseases. A variety of statistical analysis are performed based on the NIS data from 2007 to 2012.

This study utilized the National (Nationwide) Impatient Sample (NIS) for the years 2007 to 2012. The data source is an inpatient dataset produced every year. The NIS is a publicly available all-payer inpatient health care dataset with national estimates of inpatient stays. NIS is a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality (AHRQ). The current study includes the estimation of Length of Stay, total charges of the treatment, total charges of the procedures and other elements using the SPSS statistical analysis software.

The study revealed several significant factors related to the Hepatitis and other Liver diseases. Hepatitis C cases remained highest among other categories of Hepatitis as Hepatitis A+E and Hepatitis B+D, Cirrhosis remained highest among Chronic Hepatitis and Hepatocellular Carcinoma for the entire period of analysis. Hepatitis C Virus was found highest among the age groups of 21 to 51 years old and males, and low-income population for the year 2007. In average Hepatitis C was found highest among the age group 52–65 years throughout the years 2008 to 2012. The White population had highest number of Hepatitis C patients, followed by the Black population and then the Hispanic population. The Medicaid and Medicare coverage were highest for hepatitis C patients among Private insurance, Self-Pay, No Charge and Other. Hepatitis C was highest in the Northeast region per 100,000 normalized populations as compared to any other region. Urban location noticed higher number of patients reported with Hepatitis C infection. Hospital Emergency admission was highest for Hepatitis C patients. Admission Source for the Hepatitis C patients showed highest from Emergency Department throughout the entire period of analysis. Destination after discharge showed that most of the patients stayed to home self-care after they discharged from the hospital, followed by short term hospital transfer and home health care. An average Length of stay for Hepatitis C patient for the entire period of analysis was around 5.73 days to 6.01 days each year. Trauma center charged most to Hepatitis C patient throughout the entire period of the analysis as compared to Elective, Urgent and emergency treatment centers. Cirrhosis shows the highest number of deaths in the hospital followed by Hepatitis C. Number of patients die of Hepatitis C is highest for age group 52 to 65 years. Biopsy Procedure is performed highest followed by Liver Transplant and Destruction of tissue throughout the entire period of the analysis. The highest number of biopsy procedures was performed for Cirrhosis patients followed by Chronic Liver disease and then Hepatitis C. The cost of Liver Transplant remained the most expensive procedure followed by Repair of Liver and Removal of Lobe throughout year 2007–2012. The results of the analysis help to determine national estimates of incidence, prevalence inpatient mortality, morbidity, severity of illness, reference for resources allocation, hospital utilization, and policy changes related treatment of Hepatitis C Virus and other liver diseases.

For the 2nd part, a new Clinical Decision Support System (CDSS) was developed using Exsys Corvid for expert analysis. CDSS is algorithmic method of data analysis to help healthcare providers make decision, improve diagnostic probabilities, patient care and reduce overall treatment expenses. Clinical Decision Support System was successfully developed for Hepatitis C diagnostics. This CDSS is medically accurate and can guide healthcare professionals through the diagnostic process. Corvid Exsys rule-based system is used for building automated expert systems. The software utilizes backward and forward chaining technique. Selected variables had been entered in decision making flow to get the final diagnosis outcome of the analysis.

The analysis is performed using Corvid Exsys software and the following variables were used in the analysis: Patient Age, Duration of disease, blood Transfusion year, Disease Symptom, liver related diseases, blood-borne reason for hepatitis, potential reason of disease by drugs, hepatitis due to other diseases and Test Performed.

Input variables: Age- “numeric”, Blood Transfusion- “More or equal to 15 years” or “Less than 15 years”, Disease symptoms- Static list with values “fatigue, weight loss, Joint/Belly pain, loss of appetite, dark urine, itchy skin/sour muscle, abdominal swelling, fever, nausea, fluid retention, confusion, jaundice, and metabolic problem.”

The symptoms include Hepatitis Free, Hepatitis Present or Inconclusive results. Confidence variable decides if hepatitis is present or not or more detailed test was needed. All the questions asked by the system during the diagnosis process are based on the clinical literature. The system can guide a clinician through the diagnostic process to achieve hepatitis results and decision-making expert system was successfully developed.

Indexing (document details)
Advisor: Mital, Dinesh
Commitee: Srinivasan, Shankar, Vyas, Riddhi
School: Rutgers The State University of New Jersey, Rutgers School of Health Professions
Department: Health Informatics
School Location: United States -- New Jersey
Source: DAI-B 82/6(E), Dissertation Abstracts International
Subjects: Bioinformatics
Keywords: Clinical decision support system, CDSS, Data analysis using SPSS, HCUP, Hepatitis, Hepatitis C, Hepatitis diagnosis, Liver diseases
Publication Number: 28091759
ISBN: 9798557039260
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