Using Explainable Artificial Intelligence to Predict Potentially Preventable Hospitalizations: A Population-Based Cohort Study in Denmark. Issue 4 (3rd April 2023)

• Record Type: Journal Article
• Authors: Riis, Anders Hammerich; Kristensen, Pia Kjær; Lauritsen, Simon Meyer; Thiesson, Bo; Jørgensen, Marianne Johansson
• Is Part Of: Medical care. Volume 61:Issue 4(2023)
• Page Start: 226
• Page End: 236
• Publication Date: 2023-04-03
• Subjects: explainable artificial intelligence -- machine learning -- prediction model -- potentially preventable hospitalizations; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001830
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: The increasing aging population and limited health care resources have placed new demands on the healthcare sector. Reducing the number of hospitalizations has become a political priority in many countries, and special focus has been directed at potentially preventable hospitalizations. Objectives: We aimed to develop an artificial intelligence (AI) prediction model for potentially preventable hospitalizations in the coming year, and to apply explainable AI to identify predictors of hospitalization and their interaction. Methods: We used the Danish CROSS-TRACKS cohort and included citizens in 2016-2017. We predicted potentially preventable hospitalizations within the following year using the citizens' sociodemographic characteristics, clinical characteristics, and health care utilization as predictors. Extreme gradient boosting was used to predict potentially preventable hospitalizations with Shapley additive explanations values serving to explain the impact of each predictor. We reported the area under the receiver operating characteristic curve, the area under the precision-recall curve, and 95% confidence intervals (CI) based on five-fold cross-validation. Results: The best performing prediction model showed an area under the receiver operating characteristic curve of 0.789 (CI: 0.782–0.795) and an area under the precision-recall curve of 0.232 (CI: 0.219–0.246). The predictors with the highest impact on the prediction model were age, prescription drugs for obstructive airway diseases, antibiotics, and use of municipality services. We found an interaction between age and use of municipality services, suggesting that citizens aged 75+ years receiving municipality services had a lower risk of potentially preventable hospitalization. Conclusion: AI is suitable for predicting potentially preventable hospitalizations. The municipality-based health services seem to have a preventive effect on potentially preventable hospitalizations.