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Predicting individual patient and hospital-level discharge using machine learning.

作者信息

Wei Jia, Zhou Jiandong, Zhang Zizheng, Yuan Kevin, Gu Qingze, Luk Augustine, Brent Andrew J, Clifton David A, Walker A Sarah, Eyre David W

机构信息

Nuffield Department of Medicine, University of Oxford, Oxford, UK.

Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

出版信息

Commun Med (Lond). 2024 Nov 18;4(1):236. doi: 10.1038/s43856-024-00673-x.


DOI:10.1038/s43856-024-00673-x
PMID:39558142
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11574281/
Abstract

BACKGROUND: Accurately predicting hospital discharge events could help improve patient flow and the efficiency of healthcare delivery. However, using machine learning and diverse electronic health record (EHR) data for this task remains incompletely explored. METHODS: We used EHR data from February-2017 to January-2020 from Oxfordshire, UK to predict hospital discharges in the next 24 h. We fitted separate extreme gradient boosting models for elective and emergency admissions, trained on the first two years of data and tested on the final year of data. We examined individual-level and hospital-level model performance and evaluated the impact of training data size and recency, prediction time, and performance in subgroups. RESULTS: Our models achieve AUROCs of 0.87 and 0.86, AUPRCs of 0.66 and 0.64, and F1 scores of 0.61 and 0.59 for elective and emergency admissions, respectively. These models outperform a logistic regression model using the same features and are substantially better than a baseline logistic regression model with more limited features. Notably, the relative performance increase from adding additional features is greater than the increase from using a sophisticated model. Aggregating individual probabilities, daily total discharge estimates are accurate with mean absolute errors of 8.9% (elective) and 4.9% (emergency). The most informative predictors include antibiotic prescriptions, medications, and hospital capacity factors. Performance remains robust across patient subgroups and different training strategies, but is lower in patients with longer admissions and those who died in hospital. CONCLUSIONS: Our findings highlight the potential of machine learning in optimising hospital patient flow and facilitating patient care and recovery.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21cd/11574281/796e335527a3/43856_2024_673_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21cd/11574281/93ea2e95eae2/43856_2024_673_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21cd/11574281/147b8ea58ac8/43856_2024_673_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21cd/11574281/4de571942e6c/43856_2024_673_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21cd/11574281/8f751de384ea/43856_2024_673_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21cd/11574281/1f9cdd235ae2/43856_2024_673_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21cd/11574281/796e335527a3/43856_2024_673_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21cd/11574281/93ea2e95eae2/43856_2024_673_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21cd/11574281/147b8ea58ac8/43856_2024_673_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21cd/11574281/4de571942e6c/43856_2024_673_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21cd/11574281/8f751de384ea/43856_2024_673_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21cd/11574281/1f9cdd235ae2/43856_2024_673_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21cd/11574281/796e335527a3/43856_2024_673_Fig6_HTML.jpg

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引用本文的文献

[1]
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[2]
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本文引用的文献

[1]
Multi-modal learning for inpatient length of stay prediction.

Comput Biol Med. 2024-3

[2]
Personalising intravenous to oral antibiotic switch decision making through fair interpretable machine learning.

Nat Commun. 2024-1-13

[3]
A deep learning approach for inpatient length of stay and mortality prediction.

J Biomed Inform. 2023-11

[4]
Health system-scale language models are all-purpose prediction engines.

Nature. 2023-7

[5]
Leveraging electronic health records for data science: common pitfalls and how to avoid them.

Lancet Digit Health. 2022-12

[6]
COVID-19 and resilience of healthcare systems in ten countries.

Nat Med. 2022-6

[7]
Improving patient flow during infectious disease outbreaks using machine learning for real-time prediction of patient readiness for discharge.

PLoS One. 2021

[8]
Machine Learning-Based Hospital Discharge Prediction for Patients With Cardiovascular Diseases: Development and Usability Study.

JMIR Med Inform. 2021-11-17

[9]
Predicting next-day discharge via electronic health record access logs.

J Am Med Inform Assoc. 2021-11-25

[10]
Adapting hospital capacity to meet changing demands during the COVID-19 pandemic.

BMC Med. 2020-10-16

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