Background: In the Australian public healthcare system, hospitals are funded based on the number of inpatient discharges and types of conditions treated (casemix). Demand for services is increasing faster than public funding and there is a need to identify and support patients that have high service usage. In 2016, the Victorian Department of Health and Human Services developed an algorithm to predict multiple unplanned admissions as part of a programme, Health Links Chronic Care (HLCC), that provided capitation funding instead of activity based funding to support patients with high admissions.
Objectives: The aim of this study was to determine whether an algorithm with higher performance than previously used algorithms could be developed to identify patients at high risk of three or more unplanned hospital admissions 12 months from discharge.
Methods: The HLCC and Hospital Unplanned Readmission Tool (HURT) models were evaluated using 34 801 unplanned inpatient episodes (27 216 patients) from 2017 to 2018 with an 8.3% prevalence of 3 or more unplanned admissions in the following year of discharge.
Results: HURT had a higher AUROC (84%, 95% CI 83.4% to 84.9% vs 71%, 95% CI 69.4% to 71.8%) than HLCC, that was statistically significant using Delong test at p<0.05.
Discussion: We found features that appear to be strong predictors of admission risk that have not been previously used in models, including socioeconomic status and social support.
Conclusion: The high AUROC, moderate sensitivity and high specificity for the HURT algorithm suggests it is a very good predictor of future multi-admission risk and that it can be used to provide targeted support for at-risk individual.
Keywords: Artificial intelligence; Decision Making, Computer-Assisted; Decision Support Systems, Clinical; Machine Learning; Public health informatics.
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