A Machine Learning Recommender System to Tailor Preference Assessments to Enhance Person-Centered Care among Nursing Home Residents

Nursing homes (NHs) using the Preferences for Everyday Living Inventory (PELI-NH) to assess important preferences and provide person-centered care find the number of items (72) to be a barrier to using the assessment. Using a sample of n = 255 NH resident responses to the PELI-NH, we used the 16 preference items from the MDS 3.0 Section F to develop a machine learning recommender system to identify additional PELI-NH items that may be important to specific residents. Much like the Netflix recommender system, our system is based on the concept of collaborative filtering whereby insights and predictions (e.g., filters) are created using the interests and preferences of many users. The algorithm identifies multiple sets of 'you might also like' patterns called association rules, based upon responses to the 16 MDS preferences that recommends an additional set of preferences with a high likelihood of being important to a specific resident. In the evaluation of the combined apriori and logistic regression approach, we obtained a high recall performance (i.e., the ratio of correctly predicted preferences compared with all predicted preferences and nonpreferences) and high precision (i.e., the ratio of correctly predicted rules with respect to the rules predicted to be true) of 80.2% and 79.2%, respectively. The recommender system successfully provides guidance on how to best tailor the preference items asked of residents and can support preference capture in busy clinical environments, contributing to the feasibility of delivering person-centered care.