JMIR Publications

ABSTRACT

Background:

Understanding and improving patient care is pivotal for healthcare providers. With increasing volumes of the Friends and Family Test (FFT) data in England, manual analysis of this patient feedback poses challenges for many healthcare organisations. This underscores the importance of automated text analysis, particularly in predicting sentiments and themes in real-time.

Objective:

Leveraging machine learning and natural language processing, this study explores the utility of a supervised algorithm to systematically test and refine the algorithm's cross-contextual performance in diverse healthcare settings, addressing variations in population characteristics, geographical locations, and care settings, ultimately driving improvements based on patient feedback.

Methods:

The text analytics algorithm initially developed in a large acute Trust in London was further tested in nine healthcare organisations with diverse care settings across England. These Trusts varied in technical capacity and resource, population demographics, and FFT free text datasets. Testing and validation of the algorithm was performed including manual coding of subset of retrospective comments. Technical infrastructure was optimised including coding environments and packages for algorithm testing and deployment. The algorithm was iteratively trained using bag of words from anonymised data, tailored to accommodate contextual variations, and tested for change in algorithm performance whilst simultaneously rectifying issues identified.

Results:

The algorithm demonstrated satisfactory overall accuracy (>75%) in predicting themes and sentiments embedded within free-text responses across a variety of care settings and population demographics. While the algorithm yielded strong and reusable models in relatively stable environments, such as adult inpatient care settings, the initial accuracy was notably lower in organizations providing services such as paediatrics and mental health. However, the accuracy of our algorithm significantly improved when individual Trust coding templates were applied. Thematic saturation was reached after the fifth organisation was recruited, and no further coding was required for the last four organisations. Subsequently, a framework and pipeline for deployment of the algorithm were developed to provide standardised approach for implementation and analysis of FFT free text, ensuring ease of use.

Conclusions:

This study represents a significant step forward in leveraging free-text FFT data for valuable insights in diverse healthcare settings through the testing and development of a robust supervised learning text analytics algorithm. The disparity in some care settings was anticipated, given that the lexicon and phraseology used was inherently different from those prevalent in adult inpatient care (where the algorithm was developed). However, these challenges were addressed with further coding and testing. This approach enhanced the accuracy and reliability of the algorithm, encouraged inter- and intra-organisational collaboration, and shared learning.