Abstract
Introduction
Emergency readmissions have been a long-time, multifaceted, unsolved problem. Developing a predictive model calibrated with hospital-specific Electronic Health Record (EHR) data could give higher prediction accuracy and insights into high-risk patients for readmission. Thus, we need to proactively introduce the necessary interventions. This study aims to investigate the relationship between features that consider significant predictors of at-risk patients for seven-day readmission through logistic regression in addition to developing several machine learning models to test the predictability of those attributes using EHR data in a Saudi Arabia-specific ED context.
Methods
Univariate and multivariate logistic regression has been used to identify the most statistically significant features that contributed to classifying readmitted and not readmitted patients. Seven different machine learning models were trained and tested, and a comparison between the best-performing model was conducted in terms of five performance metrics. To construct the prediction model and internally validate it, the processed dataset was split into two sets: 70% for the training set and 30% for the test set or validation set.
Results
XGBoost achieved the highest accuracy (64%) in predicting early seven-day readmissions. Catboost was the second-best predictive model at 61%. XGBoost achieved the highest specificity at 70%, and all the models had a sensitivity of 57% except for XGBoost and Catboost at 32% and 38%, respectively. All predictive attributes, patient age, length of stay (LOS) in minutes, visit time (AM), marital status (married), number of medications, and number of abnormal lab results were significant predictors of early seven-day readmissions while marital status and number of vital-sign instabilities at discharge were not statistically significant predictors of seven-day readmission.
Conclusion
Although XGBoost and Catboost showed good accuracy, none of the models achieved good discriminative ability in terms of sensitivity and specificity. Thus, none can be clinically used for predicting early seven-day readmission. More predictive variables need to be fed into the model, specifically predictors approximate to the day of discharge, in order to optimize the model’s performance.