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{
    "pk": 14820,
    "title": "Documentation of Screening for Firearm Access by Healthcare Providers in the Veterans Healthcare System:  A Retrospective Study",
    "subtitle": null,
    "abstract": "Introduction: \nPresence of a firearm is associated with increased risk of violence and suicide. United States military veterans are at disproportionate risk of suicide. Routine healthcare provider screening of firearm access may prompt counseling on safe storage and handling of firearms. The objective of this study was to determine the frequency with which Veterans Health Administration (VHA) healthcare providers document firearm access in electronic health record (EHR) clinical notes, and whether this varied by patient characteristics.\n \nMethods: \nThe study sample is a post-9-11 cohort of veterans in their first year of VHA care, with at least one outpatient care visit between 2012-2017 (N = 762,953). Demographic data, veteran military service characteristics, and clinical comorbidities were obtained from VHA EHR. We extracted clinical notes for outpatient visits to primary, urgent, or emergency clinics (total 105,316,004). Natural language processing and machine learning (ML) approaches were used to identify documentation of firearm access. A taxonomy of firearm terms was identified and manually annotated with text anchored by these terms, and then trained the ML algorithm. The random-forest algorithm achieved 81.9% accuracy in identifying documentation of firearm access.\n \nResults:\nThe proportion of patients with EHR-documented access to one or more firearms during their first year of care in the VHA was relatively low and varied by patient characteristics. Men had significantly higher documentation of firearms than women (9.8% vs 7.1%; P < .001) and veterans >50 years old had the lowest (6.5%). Among veterans with any firearm term present, only 24.4% were classified as positive for access to a firearm (24.7% of men and 20.9% of women).\n \nConclusion:\n Natural language processing can identify documentation of access to firearms in clinical notes with acceptable accuracy, but there is a need for investigation into facilitators and barriers for providers and veterans to improve a systemwide process of firearm access screening. Screening, regardless of race/ethnicity, gender, and age, provides additional opportunities to protect veterans from self-harm and violence.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Firearm, guns, gun safety, electronic medical record, Veterans, screening, suicide, NLP, ML"
        }
    ],
    "section": "Violence Assessment and Prevention",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/08f6g1nz",
    "frozenauthors": [
        {
            "first_name": "Cynthia",
            "middle_name": "A.",
            "last_name": "Brandt",
            "name_suffix": "",
            "institution": "VA Connecticut Healthcare System, West Haven, Connecticut\nYale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut",
            "department": "None"
        },
        {
            "first_name": "T.",
            "middle_name": "Elizabeth",
            "last_name": "Workman",
            "name_suffix": "",
            "institution": "The George Washington University, Biomedical Informatics Center, Washington, District of Columbia\nVA Medical Center, Washington, District of Columbia",
            "department": "None"
        },
        {
            "first_name": "Melissa",
            "middle_name": "M.",
            "last_name": "Farmer",
            "name_suffix": "",
            "institution": "Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Kathleen",
            "middle_name": "M.",
            "last_name": "Akgün",
            "name_suffix": "",
            "institution": "VA Connecticut Healthcare System, West Haven, Connecticut \nYale School of Medicine, Department of Internal Medicine, New Haven, Connecticut",
            "department": "None"
        },
        {
            "first_name": "Erica",
            "middle_name": "A.",
            "last_name": "Abel",
            "name_suffix": "",
            "institution": "VA Connecticut Healthcare System, West Haven, Connecticut \nYale School of Medicine, Department of Psychiatry, New Haven, Connecticut",
            "department": "None"
        },
        {
            "first_name": "Melissa",
            "middle_name": "",
            "last_name": "Skanderson",
            "name_suffix": "",
            "institution": "VA Connecticut Healthcare System, West Haven, Connecticut",
            "department": "None"
        },
        {
            "first_name": "Bevanne",
            "middle_name": "",
            "last_name": "Bean-Mayberry",
            "name_suffix": "",
            "institution": "Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California\nUCLA David Geffen School of Medicine, Department of Medicine, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Qing",
            "middle_name": "",
            "last_name": "Zeng-Treitler",
            "name_suffix": "",
            "institution": "The George Washington University, Biomedical Informatics Center, Washington, District of Columbia\nVA Medical Center, Washington, District of Columbia",
            "department": "None"
        },
        {
            "first_name": "Maryann",
            "middle_name": "",
            "last_name": "Mason",
            "name_suffix": "",
            "institution": "Northwestern University, Department of Emergency Medicine, Chicago, Illinois",
            "department": "None"
        },
        {
            "first_name": "Lori",
            "middle_name": "A.",
            "last_name": "Bastian",
            "name_suffix": "",
            "institution": "VA Connecticut Healthcare System, West Haven, Connecticut \nYale School of Medicine, Department of Internal Medicine, New Haven, Connecticut",
            "department": "None"
        },
        {
            "first_name": "Joseph",
            "middle_name": "L.",
            "last_name": "Goulet",
            "name_suffix": "",
            "institution": "VA Connecticut Healthcare System, West Haven, Connecticut \nYale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut",
            "department": "None"
        },
        {
            "first_name": "Lori",
            "middle_name": "A.",
            "last_name": "Post",
            "name_suffix": "",
            "institution": "Northwestern University, Department of Emergency Medicine, Chicago, Illinois\nNorthwestern University, Department of Geriatric Medicine, Chicago, Illinois",
            "department": "None"
        }
    ],
    "date_submitted": "2020-12-17T01:21:34+05:30",
    "date_accepted": "2020-12-17T01:21:34+05:30",
    "date_published": "2021-05-20T01:20:12+05:30",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/14820/galley/7534/download/"
        }
    ]
}