Sentiment Measured in Hospital Discharge Notes Is Associated with Readmission and Mortality Risk: An Electronic Health Record Study

Natural language processing tools allow the characterization of sentiment--that is, terms expressing positive and negative emotion--in text. Applying such tools to electronic health records may provide insight into meaningful patient or clinician features not captured in coded data alone. We performed sentiment analysis on 2,484 hospital discharge notes for 2,010 individuals from a psychiatric inpatient unit, as well as 20,859 hospital discharges for 15,011 individuals from general medical units, in a large New England health system between January 2011 and 2014. The primary measures of sentiment captured intensity of subjective positive or negative sentiment expressed in the discharge notes. Mean scores were contrasted between sociodemographic and clinical groups in mixed effects regression models. Discharge note sentiment was then examined for association with risk for readmission in Cox regression models. Discharge notes for individuals with greater medical comorbidity were modestly but significantly lower in positive sentiment among both psychiatric and general medical cohorts (p<0.001 in each). Greater positive sentiment at discharge was associated with significantly decreased risk of hospital readmission in each cohort (~12% decrease per standard deviation above the mean). Automated characterization of discharge notes in terms of sentiment identifies differences between sociodemographic groups, as well as in clinical outcomes, and is not explained by differences in diagnosis. Clinician sentiment merits investigation to understand why and how it reflects or impacts outcomes.