Triaging Patients With Artificial Intelligence for Respiratory Symptoms in Primary Care to Improve Patient Outcomes: A Retrospective Diagnostic Accuracy Study.

Abstract

Respiratory symptoms are the most common presenting complaint in primary care. Often these symptoms are self resolving, but they can indicate a severe illness. With increasing physician workload and health care costs, triaging patients before in-person consultations would be helpful, possibly offering low-risk patients other means of communication. The objective of this study was to train a machine learning model to triage patients with respiratory symptoms before visiting a primary care clinic and examine patient outcomes in the context of the triage. We trained a machine learning model, using clinical features only available before a medical visit. Clinical text notes were extracted from 1,500 records for patients that received 1 of 7 <i>International Classification of Diseases 10th Revision</i> codes (J00, J10, JII, J15, J20, J44, J45). All primary care clinics in the Reykjavík area of Iceland were included. The model scored patients in 2 extrinsic data sets and divided them into 10 risk groups (higher values having greater risk). We analyzed selected outcomes in each group. Risk groups 1 through 5 consisted of younger patients with lower C-reactive protein values, re-evaluation rates in primary and emergency care, antibiotic prescription rates, chest x-ray (CXR) referrals, and CXRs with signs of pneumonia, compared with groups 6 through 10. Groups 1 through 5 had no CXRs with signs of pneumonia or diagnosis of pneumonia by a physician. The model triaged patients in line with expected outcomes. The model can reduce the number of CXR referrals by eliminating them in risk groups 1 through 5, thus decreasing clinically insignificant incidentaloma findings without input from clinicians.