title: A predictive analytics approach to reducing 30-day avoidable readmissions among patients with heart failure, acute myocardial infarction, pneumonia, or COPD.
abstract: Hospital readmission has become a critical metric of quality and cost of healthcare. Medicare anticipates that nearly $17 billion is paid out on the 20 % of patients who are readmitted within 30 days of discharge. Although several interventions such as transition care management have been practiced in recent years, the effectiveness and sustainability depends on how well they can identify patients at high risk of rehospitalization. Based on the literature, most current risk prediction models fail to reach an acceptable accuracy level; none of them considers patient's history of readmission and impacts of patient attribute changes over time; and they often do not discriminate between planned and unnecessary readmissions. Tackling such drawbacks, we develop a new readmission metric based on administrative data that can identify potentially avoidable readmissions from all other types of readmission. We further propose a tree-based classification method to estimate the predicted probability of readmission that can directly incorporate patient's history of readmission and risk factors changes over time. The proposed methods are validated with 2011-12 Veterans Health Administration data from inpatients hospitalized for heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease in the State of Michigan. Results shows improved discrimination power compared to the literature (c-statistics >80 %) and good calibration.
authors.affiliation: Healthcare Systems Engineering Group, Wayne State University, Detroit, MI, 48201, USA, er7671@wayne.edu.
authors.forename: Issac
authors.initials: I
authors.lastname: Shams
authors.forename: Saeede
authors.initials: S
authors.lastname: Ajorlou
authors.forename: Kai
authors.initials: K
authors.lastname: Yang
mesh_terms: D000368:Aged; D000465:Algorithms; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000706:statistics & numerical data; D015897:Comorbidity; D003627:Data Interpretation, Statistical; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000628:therapy*; D011336:Probability; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011787:Quality of Health Care; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data