Improving hospital readmission prediction using individualized utility analysis

Abstract

OBJECTIVE\nMachine learning (ML) models for allocating readmission-mitigating interventions are typically selected according to their discriminative ability, which may not necessarily translate into utility in allocation of resources. Our objective was to determine whether ML models for allocating readmission-mitigating interventions have different usefulness based on their overall utility and discriminative ability.\n\n\nMATERIALS AND METHODS\nWe conducted a retrospective utility analysis of ML models using claims data acquired from the Optum Clinformatics Data Mart, including 513,495 commercially-insured inpatients (mean [SD] age 69 [19] years; 294,895 [57%] Female) over the period January 2016 through January 2017 from all 50 states with mean 90 day cost of $11,552. Utility analysis estimates the cost, in dollars, of allocating interventions for lowering readmission risk based on the reduction in the 90-day cost.\n\n\nRESULTS\nAllocating readmission-mitigating interventions based on a GBDT model trained to predict readmissions achieved an estimated utility gain of $104 per patient, and an AUC of 0.76 (95% CI 0.76, 0.77); allocating interventions based on a model trained to predict cost as a proxy achieved a higher utility of $175.94 per patient, and an AUC of 0.62 (95% CI 0.61, 0.62). A hybrid model combining both intervention strategies is comparable with the best models on either metric. Estimated utility varies by intervention cost and efficacy, with each model performing the best under different intervention settings.\n\n\nCONCLUSION\nWe demonstrate that machine learning models may be ranked differently based on overall utility and discriminative ability. Machine learning models for allocation of limited health resources should consider directly optimizing for utility.