Dataset Information

Dynamic prediction of hospital admission with medical claim data.

ABSTRACT: BACKGROUND:Congestive heart failure is one of the most common reasons those aged 65 and over are hospitalized in the United States, which has caused a considerable economic burden. The precise prediction of hospitalization caused by congestive heart failure in the near future could prevent possible hospitalization, optimize the medical resources, and better meet the healthcare needs of patients. METHODS:To fully utilize the monthly-updated claim feed data released by The Centers for Medicare and Medicaid Services (CMS), we present a dynamic random survival forest model adapted for periodically updated data to predict the risk of adverse events. We apply our model to dynamically predict the risk of hospital admission among patients with congestive heart failure identified using the Accountable Care Organization Operational System Claim and Claim Line Feed data from Feb 2014 to Sep 2015. We benchmark the proposed model with two commonly used models in medical application literature: the cox proportional model and logistic regression model with L-1 norm penalty. RESULTS:Results show that our model has high Area-Under-the-ROC-Curve across time points and C-statistics. In addition to the high performance, it provides measures of variable importance and individual-level instant risk. CONCLUSION:We present an efficient model adapted for periodically updated data such as the monthly updated claim feed data released by CMS to predict the risk of hospitalization. In addition to processing big-volume periodically updated stream-like data, our model can capture event onset information and time-to-event information, incorporate time-varying features, provide insights of variable importance and have good prediction power. To the best of our knowledge, it is the first work combining sliding window technique with the random survival forest model. The model achieves remarkable performance and could be easily deployed to monitor patients in real time.

SUBMITTER: Yang T

PROVIDER: S-EPMC6354329 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Dynamic prediction of hospital admission with medical claim data.

Yang Tianzhong T Yang Yang Y Jia Yugang Y Li Xiao X

BMC medical informatics and decision making 20190131 Suppl 1

<h4>Background</h4>Congestive heart failure is one of the most common reasons those aged 65 and over are hospitalized in the United States, which has caused a considerable economic burden. The precise prediction of hospitalization caused by congestive heart failure in the near future could prevent possible hospitalization, optimize the medical resources, and better meet the healthcare needs of patients.<h4>Methods</h4>To fully utilize the monthly-updated claim feed data released by The Centers f ...[more]

PMID: 30700290

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Project description:OBJECTIVES:Evaluating whether future studies to develop prediction models for early readmissions based on health insurance claims data available at the time of a hospitalisation are worthwhile. DESIGN:Retrospective cohort study of hospital admissions with discharge dates between 1 January 2014 and 31 December 2016. SETTING:All-cause acute care hospital admissions in the general population of Switzerland, enrolled in the Helsana Group, a large provider of Swiss mandatory health insurance. PARTICIPANTS:The mean age of 138 222 hospitalised adults included in the study was 60.5 years. Patients were included only with their first index hospitalisation. Patients who deceased during the follow-up period were excluded, as well as patients admitted from and/or discharged to nursing homes or rehabilitation clinics. MEASURES:The primary outcome was 30-day readmission rate. Area under the receiver operating characteristic curve (AUC) was used to measure the discrimination of the developed logistic regression prediction model. Candidate variables were theory based and derived from a systematic literature search. RESULTS:We observed a 30-day readmission rate of 7.5%. Fifty-five candidate variables were identified. The final model included pharmacy-based cost group (PCG) cancer, PCG cardiac disease, PCG pain, emergency index admission, number of emergency visits, costs specialists, costs hospital outpatient, costs laboratory, costs therapeutic devices, costs physiotherapy, number of outpatient visits, sex, age group and geographical region as predictors. The prediction model achieved an AUC of 0.60 (95% CI 0.60 to 0.61). CONCLUSIONS:Based on the results of our study, it is not promising to invest resources in large-scale studies for the development of prediction tools for hospital readmissions based on health insurance claims data available at admission. The data proved appropriate to investigate the occurrence of hospitalisations and subsequent readmissions, but we did not find evidence for the potential of a clinically helpful prediction tool based on patient-sided variables alone.

Project description:Risk assessment of in-hospital mortality of patients at the time of hospitalization is necessary for determining the scale of required medical resources for the patient depending on the patient's severity. Because recent machine learning application in the clinical area has been shown to enhance prediction ability, applying this technique to this issue can lead to an accurate prediction model for in-hospital mortality prediction. In this study, we aimed to generate an accurate prediction model of in-hospital mortality using machine learning techniques. Patients 18 years of age or older admitted to the University of Tokyo Hospital between January 1, 2009 and December 26, 2017 were used in this study. The data were divided into a training/validation data set (n = 119,160) and a test data set (n = 33,970) according to the time of admission. The prediction target of the model was the in-hospital mortality within 14 days. To generate the prediction model, 25 variables (age, sex, 21 laboratory test items, length of stay, and mortality) were used to predict in-hospital mortality. Logistic regression, random forests, multilayer perceptron, and gradient boost decision trees were performed to generate the prediction models. To evaluate the prediction capability of the model, the model was tested using a test data set. Mean probabilities obtained from trained models with five-fold cross-validation were used to calculate the area under the receiver operating characteristic (AUROC) curve. In a test stage using the test data set, prediction models of in-hospital mortality within 14 days showed AUROC values of 0.936, 0.942, 0.942, and 0.938 for logistic regression, random forests, multilayer perceptron, and gradient boosting decision trees, respectively. Machine learning-based prediction of short-term in-hospital mortality using admission laboratory data showed outstanding prediction capability and, therefore, has the potential to be useful for the risk assessment of patients at the time of hospitalization.

Project description:ImportanceDelirium at admission is associated with increased hospital morbidity and mortality, but it may be missed in up to 70% of cases. Use of a predictive algorithm in an electronic medical record (EMR) system could provide critical information to target assessment of those with delirium at admission.ObjectivesTo develop and assess a prediction rule for delirium using 2 populations of veterans and compare this rule with previously confirmed rules.Design, setting, and participantsIn a diagnostic study, randomly selected EMRs of hospitalized veterans from the Veterans Affairs (VA) External Peer Review Program at 118 VA medical centers with inpatient facilities were reviewed for delirium risk factors associated with the National Institute for Health and Clinical Excellence (NICE) delirium rule in a derivation cohort (October 1, 2012, to September 30, 2013) and a confirmation cohort (October 1, 2013, to March 31, 2014). Delirium within 24 hours of admission was identified using key word terms. A total of 39 377 veterans 65 years or older who were admitted to a VA medical center for congestive heart failure, acute coronary syndrome, community-acquired pneumonia, and chronic obstructive pulmonary disease were included in the study.ExposureThe EMR calculated delirium risk.Main outcomes and measuresDelirium at admission as identified by trained nurse reviewers was the main outcome measure. Random forest methods were used to identify accurate risk factors for prevalent delirium. A prediction rule for prevalent delirium was developed, and its diagnostic accuracy was tested in the confirmation cohort. This consolidated NICE rule was compared with previously confirmed scoring algorithms (electronic NICE and Pendlebury NICE).ResultsA total of 27?625 patients were included in the derivation cohort (28 118 [92.2%] male; mean [SD] age, 75.95 [8.61] years) and 11 752 in the confirmation cohort (11 536 [98.2%] male; mean [SD] age, 75.43 [8.55] years). Delirium at admission was identified in 2343 patients (8.5%) in the derivation cohort and 882 patients (7.0%) in the confirmation cohort. Modeling techniques identified cognitive impairment, infection, sodium level, and age of 80 years or older as the dominant risk factors. The consolidated NICE rule (area under the receiver operating characteristic [AUROC] curve, 0.91; 95% CI, 0.91-0.92; P?<?.001) had significantly higher discriminatory function than the eNICE rule (AUROC curve, 0.81; 95% CI, 0.80-0.82; P?<?.001) or Pendlebury NICE rule (AUROC curve, 0.87; 95% CI, 0.86-0.88; P?<?.001). These findings were confirmed in the confirmation cohort.Conclusions and relevanceThis analysis identified preexisting cognitive impairment, infection, sodium level, and age of 80 years or older as delirium screening targets. Use of this algorithm in an EMR system could direct clinical assessment efforts to patients with delirium at admission.

Project description:BackgroundTelemonitoring of symptoms and physiological signs has been suggested as a means of early detection of chronic obstructive pulmonary disease (COPD) exacerbations, with a view to instituting timely treatment. However, algorithms to identify exacerbations result in frequent false-positive results and increased workload. Machine learning, when applied to predictive modelling, can determine patterns of risk factors useful for improving prediction quality.ObjectiveOur objectives were to (1) establish whether machine learning techniques applied to telemonitoring datasets improve prediction of hospital admissions and decisions to start corticosteroids, and (2) determine whether the addition of weather data further improves such predictions.MethodsWe used daily symptoms, physiological measures, and medication data, with baseline demography, COPD severity, quality of life, and hospital admissions from a pilot and large randomized controlled trial of telemonitoring in COPD. We linked weather data from the United Kingdom meteorological service. We used feature selection and extraction techniques for time series to construct up to 153 predictive patterns (features) from symptom, medication, and physiological measurements. We used the resulting variables to construct predictive models fitted to training sets of patients and compared them with common symptom-counting algorithms.ResultsWe had a mean 363 days of telemonitoring data from 135 patients. The two most practical traditional score-counting algorithms, restricted to cases with complete data, resulted in area under the receiver operating characteristic curve (AUC) estimates of 0.60 (95% CI 0.51-0.69) and 0.58 (95% CI 0.50-0.67) for predicting admissions based on a single day's readings. However, in a real-world scenario allowing for missing data, with greater numbers of patient daily data and hospitalizations (N=57,150, N+=55, respectively), the performance of all the traditional algorithms fell, including those based on 2 days' data. One of the most frequently used algorithms performed no better than chance. All considered machine learning models demonstrated significant improvements; the best machine learning algorithm based on 57,150 episodes resulted in an aggregated AUC of 0.74 (95% CI 0.67-0.80). Adding weather data measurements did not improve the predictive performance of the best model (AUC 0.74, 95% CI 0.69-0.79). To achieve an 80% true-positive rate (sensitivity), the traditional algorithms were associated with an 80% false-positive rate: our algorithm halved this rate to approximately 40% (specificity approximately 60%). The machine learning algorithm was moderately superior to the best symptom-counting algorithm (AUC 0.77, 95% CI 0.74-0.79 vs AUC 0.66, 95% CI 0.63-0.68) at predicting the need for corticosteroids.ConclusionsEarly detection and management of COPD remains an important goal given its huge personal and economic costs. Machine learning approaches, which can be tailored to an individual's baseline profile and can learn from experience of the individual patient, are superior to existing predictive algorithms and show promise in achieving this goal.Trial registrationInternational Standard Randomized Controlled Trial Number ISRCTN96634935; http://www.isrctn.com/ISRCTN96634935 (Archived by WebCite at http://www.webcitation.org/722YkuhAz).

Project description:BackgroundThe growing number of patients visiting pediatric emergency departments could have a detrimental impact on the care provided to children who are triaged as needing urgent attention. Therefore, it has become essential to continuously monitor and analyze the admissions and waiting times of pediatric emergency patients. Despite the significant challenge posed by the shortage of pediatric medical resources in China's health care system, there have been few large-scale studies conducted to analyze visits to the pediatric emergency room.ObjectiveThis study seeks to examine the characteristics and admission patterns of patients in the pediatric emergency department using electronic medical record (EMR) data. Additionally, it aims to develop and assess machine learning models for predicting waiting times for pediatric emergency department visits.MethodsThis retrospective analysis involved patients who were admitted to the emergency department of Children's Hospital Capital Institute of Pediatrics from January 1, 2021, to December 31, 2021. Clinical data from these admissions were extracted from the electronic medical records, encompassing various variables of interest such as patient demographics, clinical diagnoses, and time stamps of clinical visits. These indicators were collected and compared. Furthermore, we developed and evaluated several computational models for predicting waiting times.ResultsIn total, 183,024 eligible admissions from 127,368 pediatric patients were included. During the 12-month study period, pediatric emergency department visits were most frequent among children aged less than 5 years, accounting for 71.26% (130,423/183,024) of the total visits. Additionally, there was a higher proportion of male patients (104,147/183,024, 56.90%) compared with female patients (78,877/183,024, 43.10%). Fever (50,715/183,024, 27.71%), respiratory infection (43,269/183,024, 23.64%), celialgia (9560/183,024, 5.22%), and emesis (6898/183,024, 3.77%) were the leading causes of pediatric emergency room visits. The average daily number of admissions was 501.44, and 18.76% (34,339/183,204) of pediatric emergency department visits resulted in discharge without a prescription or further tests. The median waiting time from registration to seeing a doctor was 27.53 minutes. Prolonged waiting times were observed from April to July, coinciding with an increased number of arrivals, primarily for respiratory diseases. In terms of waiting time prediction, machine learning models, specifically random forest, LightGBM, and XGBoost, outperformed regression methods. On average, these models reduced the root-mean-square error by approximately 17.73% (8.951/50.481) and increased the R2 by approximately 29.33% (0.154/0.525). The SHAP method analysis highlighted that the features "wait.green" and "department" had the most significant influence on waiting times.ConclusionsThis study offers a contemporary exploration of pediatric emergency room visits, revealing significant variations in admission rates across different periods and uncovering certain admission patterns. The machine learning models, particularly ensemble methods, delivered more dependable waiting time predictions. Patient volume awaiting consultation or treatment and the triage status emerged as crucial factors contributing to prolonged waiting times. Therefore, strategies such as patient diversion to alleviate congestion in emergency departments and optimizing triage systems to reduce average waiting times remain effective approaches to enhance the quality of pediatric health care services in China.

Dataset Information

Dynamic prediction of hospital admission with medical claim data.

Publications

Dynamic prediction of hospital admission with medical claim data.

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