Abstract:
INTRODUCTION:This article is part of the Focus Theme of Methods of Information in Medicine on "Big Data and Analytics in Healthcare". BACKGROUND:Hospital readmissions raise healthcare costs and cause significant distress to providers and patients. It is, therefore, of great interest to healthcare organizations to predict what patients are at risk to be readmitted to their hospitals. However, current logistic regression based risk prediction models have limited prediction power when applied to hospital administrative data. Meanwhile, although decision trees and random forests have been applied, they tend to be too complex to understand among the hospital practitioners. OBJECTIVES:Explore the use of conditional logistic regression to increase the prediction accuracy. METHODS:We analyzed an HCUP statewide inpatient discharge record dataset, which includes patient demographics, clinical and care utilization data from California. We extracted records of heart failure Medicare beneficiaries who had inpatient experience during an 11-month period. We corrected the data imbalance issue with under-sampling. In our study, we first applied standard logistic regression and decision tree to obtain influential variables and derive practically meaning decision rules. We then stratified the original data set accordingly and applied logistic regression on each data stratum. We further explored the effect of interacting variables in the logistic regression modeling. We conducted cross validation to assess the overall prediction performance of conditional logistic regression (CLR) and compared it with standard classification models. RESULTS:The developed CLR models outperformed several standard classification models (e.g., straightforward logistic regression, stepwise logistic regression, random forest, support vector machine). For example, the best CLR model improved the classification accuracy by nearly 20% over the straightforward logistic regression model. Furthermore, the developed CLR models tend to achieve better sensitivity of more than 10% over the standard classification models, which can be translated to correct labeling of additional 400 - 500 readmissions for heart failure patients in the state of California over a year. Lastly, several key predictor identified from the HCUP data include the disposition location from discharge, the number of chronic conditions, and the number of acute procedures. CONCLUSIONS:It would be beneficial to apply simple decision rules obtained from the decision tree in an ad-hoc manner to guide the cohort stratification. It could be potentially beneficial to explore the effect of pairwise interactions between influential predictors when building the logistic regression models for different data strata. Judicious use of the ad-hoc CLR models developed offers insights into future development of prediction models for hospital readmissions, which can lead to better intuition in identifying high-risk patients and developing effective post-discharge care strategies. Lastly, this paper is expected to raise the awareness of collecting data on additional markers and developing necessary database infrastructure for larger-scale exploratory studies on readmission risk prediction.
journal_name
Methods Inf Medjournal_title
Methods of information in medicineauthors
Zhu K,Lou Z,Zhou J,Ballester N,Kong N,Parikh Pdoi
10.3414/ME14-02-0017subject
Has Abstractpub_date
2015-01-01 00:00:00pages
560-7issue
6eissn
0026-1270issn
2511-705Xpii
14-02-0017journal_volume
54pub_type
杂志文章abstract:OBJECTIVES:Personal digital assistants (PDAs) are in widespread use by resident physicians in many countries, reaching as high as 95% in some reports. Uses are varied and include clinical decision support and support of evidence-based practice. Utilization by resident doctors in Japan has not been characterized. This s...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:10.3414/ME0607
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVE:The objective of this study is to develop a solution to preserve security and privacy in a healthcare environment where health-sensitive information will be accessed by many parties and stored in various distributed databases. The solution should maintain anonymous medical records and it should be able to lin...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:10.3414/me9116
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:This article describes the development and evaluation of a distributed user interface (DUI) application to assess visuomotor organization ability. This application enables therapists to evaluate the acquired brain injury (ABI) on patients, and patients, to perform the assessment on a touch screen while thera...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:10.1055/s-0040-1713086
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVES:The huge amount of released medical apps prevents medical app users from believing that medical scientific societies and other accreditation bodies as well, have the resources and the power for assigning to any medical app a quality score. By the time being, any medical app user has to take the risks related...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:10.3414/ME13-01-0093
更新日期:2014-01-01 00:00:00
abstract:OBJECTIVES:The National Cancer Institute (NCI) has developed the Common Data Elements (CDE) to serve as a controlled vocabulary of data descriptors for cancer research, to facilitate data interchange and inter-operability between cancer research centers. We evaluated CDE's structure to see whether it could represent th...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:2006-01-01 00:00:00
abstract::Pathfinder is an expert system that assists surgical pathologists with the diagnosis of lymph-node diseases. The program is one of a growing number of normative expert systems that use probability and decision theory to acquire, represent, manipulate, and explain uncertain medical knowledge. In this article, we descri...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:1992-06-01 00:00:00
abstract:OBJECTIVES:Our objective was to design and develop a mobile clinical decision support system for emergency triage of different acute pain presentations. The system should interact with existing hospital information systems, run on mobile computing devices (handheld computers) and be suitable for operation in weak-conne...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:2005-01-01 00:00:00
abstract::For use in system development, a method based on both qualitative and quantitative data was employed to study the difficulties--the dilemmas--a general practitioner (GP) faces during daily consultations. Video recordings were used for stimulated recall of the consultation. From 46 consultations, 262 dilemmas were iden...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:1990-01-01 00:00:00
abstract:INTRODUCTION:This article is part of the Focus Theme of Methods of Information in Medicine on "Biosignal Interpretation: Advanced Methods for Studying Cardiovascular and Respiratory Systems". BACKGROUND:Adaptation of the QT-interval to changes in heart rate reflects on the body-surface electrocardiogram the adaptation...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:10.3414/ME13-02-0039
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:The cause-of-death register at the Southern Urals Biophysics Institute (SUBI), Ozyorsk, Russia, was established to document the number and causes of deaths in the Mayak workers cohort, which includes all persons (N = 22,377) employed at Mayak nuclear facility between 1948 and 1982. Most workers were occupati...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:10.3414/ME11-01-0049
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVES:The main objective of the research is an application of the clustering and cluster validity methods to estimate the number of clusters in cancer tumor datasets. A weighed voting technique is going to be used to improve the prediction of the number of clusters based on different data mining techniques. These ...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:2006-01-01 00:00:00
abstract:OBJECTIVES:Combination of multiple testing and modeling techniques in dose-response studies. Use of hypotheses tests to assess the significance of the dose-response signal associated with a given candidate dose-response model. Estimation of target dose(s) following the previous model selection step. Illustration of the...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:For the statistical analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) data, compartment models are a commonly used tool. By these models, the observed uptake of contrast agent in some tissue over time is linked to physiologic properties like capillary permeability and blood flow. Up ...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:10.3414/ME14-01-0131
更新日期:2016-01-01 00:00:00
abstract::Medical informaticians are multidisciplinary professionals responsible for developing complex technical systems. The aim of this study was to investigate how a code of ethics can help medical informaticians in avoiding design failures. An exploratory case study was performed to identify factors related to failure duri...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:1999-06-01 00:00:00
abstract::Three ways are proposed to help the occupational physician in constructing a worker's job history or Curriculum Laboris (CL) with a PC. The quality and, therefore, the usefulness of any job history is greatly conditioned by the method and quality of data collection. The Curriculum Laboris method explained in a previou...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:1990-03-01 00:00:00
abstract:OBJECTIVES:Cerebral ventricular volume has the potential to become an important parameter in quantitative neurological diagnosis. However, no accepted methodology for routine clinical use exists to date. We sought a robust, reproducible, and fast technique to evaluate cerebral ventricular volume in young children. MET...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVES:The objective of this study was to explore suitable spatial filters for inverse estimation of cortical potentials from the scalp electroencephalogram. The effect of incorporating noise covariance into inverse procedures was examined by computer simulations and tested in human experiment. METHODS:The paramet...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:2004-01-01 00:00:00
abstract::Acute appendicitis is the most common cause of acute abdomen requiring surgical intervention. The clinical diagnosis of acute appendicitis is not always easy due to variable symptomatology, particularly at the onset. The contributions of history-taking and physical examination in the diagnosis of acute appendicitis wa...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:1994-05-01 00:00:00
abstract:BACKGROUND:Physical rehabilitation exergames (PREGs) are suitable for motivating patients toward completing treatments. Leap Motion (LM) is a motion sensor that may be useful for developing PREGs targeted at hands and fingers rehabilitation. Therefore, knowing the advantages and limitations of LM is relevant to underst...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:10.1055/s-0040-1715127
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVES:As millions of consumers perform health information retrieval online, the mismatch between their terminology and the terminologies of the information sources could become a major barrier to successful retrievals. To address this problem, we studied the characteristics of consumer terminology for health infor...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:2002-01-01 00:00:00
abstract::The increased use of computers is a response to the considerable growth in information in all fields of activities. Related to this, in the field of medicine a new component appeared about 40 years ago: Medical Informatics. Its goals are to assist health care professionals in the choice of data to manage and in the ch...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:1997-02-01 00:00:00
abstract:BACKGROUND:ICD is used for coding medical diagnoses across the world, but there is no globally accepted coding system for health care procedures. The need for the introduction of a common international medical procedure classification has been addressed by the Australian NCCH, which proposed the International Classific...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:10.3414/ME09-01-0007
更新日期:2009-01-01 00:00:00
abstract::The use of computers in the health sector has increased significantly during the last few years in Nigeria. This paper addresses the integration of health and informatics education, or health education and informatics education, or informatics education in health care delivery. It gives an introduction to the status o...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:1997-02-01 00:00:00
abstract::A few years ago, a new method of survival analysis, denoted period analysis, has been developed to derive more up-to-date estimates of long-term survival rates of cancer patients, but this method has rarely been applied so far. Using empirical examples from the Saarland Cancer Registry, we illustrate how seriously tra...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:2001-07-01 00:00:00
abstract:BACKGROUND:Studying workflow is a critical step in designing, implementing and evaluating informatics interventions in complex sociotechnical settings, such as hospital emergency departments (EDs). Known approaches to studying workflow in clinical settings attend to the activities of individual clinicians, thus being i...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:10.3414/ME12-01-0079
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:The use of electronic medical record (EMR) is anticipated to bring benefits for patients, physicians, and organizations. But limited physicians' acceptance of EMR presents a serious threat to its effective implementation. OBJECTIVES:The current study incorporates technology acceptance model (TAM) with two a...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:10.1055/s-0039-1695718
更新日期:2019-12-01 00:00:00
abstract:OBJECTIVES:The European GEMSS Project is concerned with the creation of medical Grid service prototypes and their evaluation in a secure service-oriented infrastructure for distributed on demand/supercomputing. Key aspects of the GEMSS Grid middleware include negotiable QoS support for time-critical service provision, ...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:2005-01-01 00:00:00
abstract::There are three grand challenges for medical informatics policy: (1) What is it? (2) What should it be? (3) How can we influence its development? To address these challenges requires: (1) an historical analysis of medical informatics policies in a representative sample of countries. This should include an account of m...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:1999-12-01 00:00:00
abstract::To examine inter-observer variation in the monitoring of patients with chronic disease, four nephrologists independently assessed 62 patients on maintenance hemodialysis. Deviation from normal was determined for adequacy of dialysis, protein intake, and metabolic state. The kappa-index, which allows to adjust for chan...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:
更新日期:1990-03-01 00:00:00
abstract:OBJECTIVE:We have been developing a decision support system that uses electronic clinical data and provides alerts to clinicians. However, the inference rules for such a system are difficult to write in terms of representing domain concepts and temporal reasoning. To address this problem, we have developed an ontology-...
journal_title:Methods of information in medicine
pub_type: 杂志文章
doi:10.3414/ME9126
更新日期:2008-01-01 00:00:00