No abstract

In this review, current studies on hospital readmission due to infection of COVID-19 were discussed, compared, and further evaluated in order to understand the current trends and progress in mitigation of hospital readmissions due to COVID-19. Boolean expression of (“COVID-19” OR “covid19” OR “covid” OR “coronavirus” OR “Sars-CoV-2”) AND (“readmission” OR “re-admission” OR “rehospitalization” OR “rehospitalization”) were used in five databases, namely Web of Science, Medline, Science Direct, Google Scholar and Scopus. From the search, a total of 253 articles were screened down to 26 articles. In overall, most of the research focus on readmission rates than mortality rate. On the readmission rate, the lowest is 4.2% by Ramos-Martínez et al. from Spain, and the highest is 19.9% by Donnelly et al. from the United States. Most of the research (n = 13) uses an inferential statistical approach in their studies, while only one uses a machine learning approach. The data size ranges from 79 to 126,137. However, there is no specific guide to set the most suitable data size for one research, and all results cannot be compared in terms of accuracy, as all research is regional studies and do not involve data from the multi region. The logistic regression is prevalent in the research on risk factors of readmission post-COVID-19 admission, despite each of the research coming out with different outcomes. From the word cloud, age is the most dominant risk factor of readmission, followed by diabetes, high length of stay, COPD, CKD, liver disease, metastatic disease, and CAD. A few future research directions has been proposed, including the utilization of machine learning in statistical analysis, investigation on dominant risk factors, experimental design on interventions to curb dominant risk factors and increase the scale of data collection from single centered to multi centered.

Hospital readmission shortly after discharge is threatening to plague the quality of inpatient care. Readmission is a severe episode that leads to increased medical care costs. Federal regulations and early readmission penalties have created an incentive for healthcare facilities to reduce their readmission rates by predicting patients at a high risk of readmission. Scientists have developed prediction models by using rule-based assessment scores and traditional statistical methods, and most have focused on structured patient records. Recently, a few researchers utilized unstructured clinical notes. However, they achieved moderate prediction accuracy by making predictions of a single diagnosis subpopulation via extensive feature engineering. This study proposes the use of machine learning to learn deep representation of patient notes for the identification of high-risk readmission in a hospital-wide population. We describe and train several predictive models (standard machine learning and neural network), to which several setups have not been applied. Results show that complex deep learning models significantly outperform (P < 0.001) conventionally applied simple models in terms of discrimination ability. We also demonstrate a simple feature evaluation using a standard model, which allows the determination of potential clinical conditions/procedures for targeting. Unlike modeling using structured patient information with considerable variability in structure when different templates or databases are adopted, this study shows that the machine learning approach can be applied to prognosticate readmission with clinical free text in various healthcare settings. Using minimum feature engineering, the trained models perform comparably well or better than other predictive models established in previous literature.

Hospital readmission shortly after discharge is contributing to rising medical care costs. Attempts have been exerted to reduce readmission rates by predicting patients at high risk of this episode on the basis of unstructured clinical notes. Discharge summary as part of the clinical prose is effective at modeling readmission risk. However, the predictive value of notes written upon discharge offers few opportunities to reduce the chance of readmission because the target patient might have already been discharged. This paper presents the use of early clinical notes in building a machine learning model to predict readmission at 48 h immediately after a patient's admission. Extensive feature engineering, testing multiple algorithms, and algorithm tuning were performed to enhance model performance. A risk scoring framework that combines the data- and knowledge-driven feature scores in risk computation was developed. The proposed predictive model showed better prognostic capability than the machine learning model alone in terms of the ability to detect readmission. In specific, the proposed algorithm showed improvements of 11%–28% in sensitivity and 1%–3% in the area-under-the-receiver operating characteristic curve.

Quality of care data has gained transparency captured through various measurements and reporting. Readmission measure is especially related to unfavorable patient outcomes that directly bends the curve of healthcare cost. Under the Hospital Readmission Reduction Program, payments to hospitals were reduced for those with excessive 30-day rehospitalization rates. These penalties have intensified efforts from hospital stakeholders to implement strategies to reduce readmission rates. One of the key strategies is the deployment of predictive analytics stratified by patient population. The recent research in readmission model is focused on making its prediction more accurate. As cost-saving improvements through artificial intelligent-based health solutions are expected, the broad economic impact of such digital tool remains unknown. Meanwhile, reducing readmission rate is associated with increased operating expenses due to targeted interventions. The increase in operating margin can surpass native readmission cost. In this paper, we propose a quantized evaluation metric to provide a methodological mean in assessing whether a predictive model represents cost-effective way of delivering healthcare. Herein, we evaluate the impact machine learning has had on transitional care and readmission with proposed metric. The final model was estimated to produce net healthcare savings at over $1 million given a 50% rate of successfully preventing a readmission.