What is the clinical evidence from this study?

Study design: Observational. Population: Medical patients and chronic pancreatitis (n=46209). Intervention: Administrative claim-based algorithm vs. State-of-the-art readmission models requiring clinical data. Primary outcome: 30-day readmission prediction performance (AUC).

September 28, 2013Open Access

Mining high-dimensional administrative claims data to predict early hospital readmissions

Key Result

An administrative claim-based algorithm predicted 30-day readmission with an AUC ≥0.75 for medical patients and ≥0.65 for chronic pancreatitis patients, performing similarly to clinical models.

Study Design

Type

Observational (n=46,209)

Multicenter

Yes

Structured PICO

Can an administrative claim-based algorithm using high-dimensional data accurately predict 30-day hospital readmissions in medical and chronic pancreatitis patients?

Population

46,209 hospital admissions, comprising medical patients (n=26,091 training, n=16,194 testing) and patients with chronic pancreatitis (n=3,218 training, n=706 testing) from two Johns Hopkins hospitals.

Intervention

Administrative claim-based algorithm to predict 30-day readmission using high-dimensional claims data (ICD-9-CM and CPT codes)

Outcome

30-day readmission prediction performance (AUC, sensitivity, specificity, positive predictive values, negative predictive values, and F-measure)

An administrative claim-based algorithm using high-dimensional data can predict 30-day hospital readmissions with performance comparable to models requiring clinical data.

Abstract

BACKGROUND: Current readmission models use administrative data supplemented with clinical information. However, the majority of these result in poor predictive performance (area under the curve (AUC)<0.70). OBJECTIVE: To develop an administrative claim-based algorithm to predict 30-day readmission using standardized billing codes and basic admission characteristics available before discharge. MATERIALS AND METHODS: The algorithm works by exploiting high-dimensional information in administrative claims data and automatically selecting empirical risk factors. We applied the algorithm to index admissions in two types of hospitalized patient: (1) medical patients and (2) patients with chronic pancreatitis (CP). We trained the models on 26,091 medical admissions and 3218 CP admissions from The Johns Hopkins Hospital (a tertiary research medical center) and tested them on 16,194 medical admissions and 706 CP admissions from Johns Hopkins Bayview Medical Center (a hospital that serves a more general patient population), and vice versa. Performance metrics included AUC, sensitivity, specificity, positive predictive values, negative predictive values, and F-measure. RESULTS: From a pool of up to 5665 International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnoses, 599 ICD-9-CM procedures, and 1815 Current Procedural Terminology codes observed, the algorithm learned a model consisting of 18 attributes from the medical patient cohort and five attributes from the CP cohort. Within-site and across-site validations had an AUC≥0.75 for the medical patient cohort and an AUC≥0.65 for the CP cohort. CONCLUSIONS: We have created an algorithm that is widely applicable to various patient cohorts and portable across institutions. The algorithm performed similarly to state-of-the-art readmission models that require clinical data.