Home Healthcare Clinicians Use Judgment Language More Frequently for Black and Hispanic Patients: A Natural Language Processing Study (Preprint)

BACKGROUND A clinician's biased behavior toward patients can affect the quality of care. Recent literature reviews report on widespread implicit biases among clinicians. Although emerging studies in hospital settings show racial biases in the language used in clinical documentation within electronic health records, no studies have yet investigated the extent of judgment language in home healthcare. OBJECTIVE We aimed to examine racial differences in judgment language use and the relationship between judgment language use and the amount of time clinicians spent on home visits as a reflection of care quality in home health care. METHODS This study is a retrospective observational cohort study. Study data were extracted from a large urban home healthcare organization in the Northeast U.S.. Study dataset included patients (n = 45,384) who received home healthcare services between 1/1/2019-12/31/2019. The study applied a natural language processing algorithm to automatically detect the language of judgment in clinical notes. RESULTS The use of judgment language was observed in 38% of patients (n=17,141). The highest use of judgment language was found in Hispanic (10.8% of all clinical notes), followed by Black (10.7%), White (9.5%), and Asian (7.8%) patients. Black and Hispanic patients were 14% more likely to have notes with judgment language than White patients. The length of a home healthcare visit was reduced by 21 minutes when judgment language was used. CONCLUSIONS Racial differences were identified in judgment language use. When judgment language is used, clinicians spend less time at patients' homes. Because language clinicians use in documentation is associated with time spent providing care, further research is needed to study the impact on quality of home health care. Policy, education, and clinical practice improvements are needed to address the biases behind judgment language. CLINICALTRIAL