title: Predicting Negative Events: Using Post-discharge Data to Detect High-Risk Patients.
abstract: Predicting negative outcomes, such as readmission or death, and detecting high-risk patients are important yet challenging problems in medical informatics. Various models have been proposed to detect high-risk patients; however, the state of the art relies on patient information collected before or at the time of discharge to predict future outcomes. In this paper, we investigate the effect of including data generated post discharge to predict negative outcomes. Specifically, we focus on two types of patients admitted to the Vanderbilt University Medical Center between 2010-2013: i) those with an acute event - 704 hip fractures and ii) those with chronic problems - 5250 congestive heart failure (CHF) patients. We show that the post-discharge model improved the AUC of the LACE index, a standard readmission scoring function, by 20 - 30%. Moreover, the new model resulted in higher AUCs by 15 - 27% for hip fracture and 10 - 12% for CHF compared to standard models.
authors.affiliation: Vanderbilt University, Nashville, TN.
authors.forename: Lina
authors.initials: L
authors.lastname: Sulieman
authors.affiliation: Vanderbilt University, Nashville, TN.
authors.forename: Daniel
authors.initials: D
authors.lastname: Fabbri
authors.affiliation: Cornell University, New York, NY.
authors.forename: Fei
authors.initials: F
authors.lastname: Wang
authors.affiliation: IBM T. J. Watson Research Center, New York, NY.
authors.forename: Jianying
authors.initials: J
authors.lastname: Hu
authors.affiliation: Vanderbilt University, Nashville, TN.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Malin
mesh_terms: D000208:Acute Disease; D019540:Area Under Curve; D002908:Chronic Disease; D057286:Electronic Health Records; D006333:Heart Failure; D006620:Hip Fractures; D006801:Humans; D015233:Models, Statistical; D010351:Patient Discharge; D010359:Patient Readmission; D011379:Prognosis