title: Discharge recommendation based on a novel technique of homeostatic analysis.
abstract: We propose a computational framework for integrating diverse patient measurements into an aggregate health score and applying it to patient stability prediction.
  
  
  
  We mapped retrospective patient data from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC) II clinical database into a discrete multidimensional space, which was searched for measurement combinations and trends relevant to patient outcomes of interest. Patient trajectories through this space were then used to make outcome predictions. As a case study, we built AutoTriage, a patient stability prediction tool to be used for discharge recommendation.
  
  
  
  AutoTriage correctly identified 3 times as many stabilizing patients as existing tools and achieved an accuracy of 92.9% (95% CI: 91.6-93.9%), while maintaining 94.5% specificity. Analysis of AutoTriage parameters revealed that interdependencies between risk factors comprised the majority of each patient stability score.
  
  
  
  AutoTriage demonstrated an improvement in the sensitivity of existing stability prediction tools, while considering patient safety upon discharge. The relative contributions of risk factors indicated that time-series trends and measurement interdependencies are most important to stability prediction.
  
  
  
  Our results motivate the application of multidimensional analysis to other clinical problems and highlight the importance of risk factor trends and interdependencies in outcome prediction.
authors.affiliation: Dascena Inc., Hayward, CA, USA.
authors.forename: Jacob S
authors.initials: JS
authors.lastname: Calvert
authors.affiliation: Dascena Inc., Hayward, CA, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Price
authors.affiliation: Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Barton
authors.affiliation: Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA.|Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA, USA.
authors.forename: Uli K
authors.initials: UK
authors.lastname: Chettipally
authors.affiliation: Dascena Inc., Hayward, CA, USA ritankar@dascena.com.
authors.forename: Ritankar
authors.initials: R
authors.lastname: Das
mesh_terms: D000328:Adult; D066264:Datasets as Topic; D003658:Decision Making, Computer-Assisted; D020000:Decision Support Systems, Clinical; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D010351:Patient Discharge; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014218:Triage / Q000379:methods
keywords: clinical decision support systems; computer-assisted diagnosis; length of stay; medical informatics; patient discharge