Competition - hospital readmissions

Reducing hospital readmissions

📖 Background

You work for a consulting company helping a hospital group better understand patient readmissions. The hospital gave you access to ten years of information on patients readmitted to the hospital after being discharged. The doctors want you to assess if initial diagnoses, number of procedures, or other variables could help them better understand the probability of readmission.

They want to focus follow-up calls and attention on those patients with a higher probability of readmission.

💾 The data

You have access to ten years of patient information (source):

Information in the file

• "age" - age bracket of the patient
• "time_in_hospital" - days (from 1 to 14)
• "n_procedures" - number of procedures performed during the hospital stay
• "n_lab_procedures" - number of laboratory procedures performed during the hospital stay
• "n_medications" - number of medications administered during the hospital stay
• "n_outpatient" - number of outpatient visits in the year before a hospital stay
• "n_inpatient" - number of inpatient visits in the year before the hospital stay
• "n_emergency" - number of visits to the emergency room in the year before the hospital stay
• "medical_specialty" - the specialty of the admitting physician
• "diag_1" - primary diagnosis (Circulatory, Respiratory, Digestive, etc.)
• "diag_2" - secondary diagnosis
• "diag_3" - additional secondary diagnosis
• "glucose_test" - whether the glucose serum came out as high (> 200), normal, or not performed
• "A1Ctest" - whether the A1C level of the patient came out as high (> 7%), normal, or not performed
• "change" - whether there was a change in the diabetes medication ('yes' or 'no')
• "diabetes_med" - whether a diabetes medication was prescribed ('yes' or 'no')
• "readmitted" - if the patient was readmitted at the hospital ('yes' or 'no')

Acknowledgments: Beata Strack, Jonathan P. DeShazo, Chris Gennings, Juan L. Olmo, Sebastian Ventura, Krzysztof J. Cios, and John N. Clore, "Impact of HbA1c Measurement on Hospital Readmission Rates: Analysis of 70,000 Clinical Database Patient Records," BioMed Research International, vol. 2014, Article ID 781670, 11 pages, 2014.

Executive Summary:

Primary Diagnosis Trends: Analysis of hospital readmission data revealed that "Circulatory" conditions are the most common primary diagnosis among older age groups, while "Other" diagnoses are prevalent in younger age groups. This highlights the need for age-specific interventions and management strategies.

• Effects of Diabetes Diagnosis on Readmission Rates: Patients with diabetes as a primary diagnosis generally exhibit higher readmission rates, especially in older age groups. However, when diabetes is a secondary diagnosis, readmission rates tend to be lower across all age groups, suggesting a lesser impact on readmission compared to primary diagnosis.

• Readmission for Diabetes as a Primary Diagnosis: Readmission rates vary across age groups, with the highest percentage observed in the 70-80 age group. Age appears to play a significant role in diabetes-related hospital readmissions, emphasizing the importance of age-specific interventions.

• Diabetes as a Secondary Diagnosis: Comparing readmission rates between diabetes as a primary and secondary diagnosis reveals that the presence of diabetes as a primary diagnosis may lead to higher readmission likelihoods compared to when it's listed as a secondary diagnosis.

• Diabetes as an Additional Secondary Diagnosis: Analysis of data including diabetes as an additional secondary diagnosis suggests an incremental effect on readmission rates compared to primary and secondary diagnosis scenarios. Understanding diagnostic hierarchy and comorbidity complexity is crucial for addressing readmission risks among diabetic patients.

Based on the analysis of hospital readmission data, the hospital should focus their follow-up efforts on the following groups of patients with a high probability of readmission:

• Elderly Patients: Patients in the age groups of 70-80 and 80-90 exhibit higher readmission rates, especially when diagnosed with diabetes as a primary or secondary condition. These age groups may benefit from targeted follow-up interventions to ensure adequate post-discharge care and prevent avoidable readmissions.

• Patients with Diabetes as a Primary Diagnosis: Patients diagnosed with diabetes as a primary condition tend to have higher readmission rates across various age groups. Hence, focusing on this cohort for close monitoring and post-discharge support can help mitigate the risk of readmissions and improve long-term health outcomes.

• Patients with Complex Comorbidities: Patients with multiple comorbidities, especially those involving circulatory conditions or other chronic diseases, are at an increased risk of readmission. Hospitals should identify and prioritize these patients for comprehensive care management programs to address their complex health needs and reduce the likelihood of readmissions.

• Recent Discharges: Implementing proactive follow-up strategies for patients recently discharged from the hospital, irrespective of age or diagnosis, can help identify early signs of deterioration or complications, thereby preventing readmissions. Providing timely support, medication management, and access to healthcare resources post-discharge can significantly reduce the risk of readmissions in this vulnerable population.

By focusing their follow-up efforts on these specific groups of patients, the hospital can effectively monitor those with a high probability of readmission, implement targeted interventions, and ultimately improve patient outcomes while optimizing healthcare resources.

In conclusion, tailoring interventions based on diagnosis hierarchy and patient age can help mitigate hospital readmissions among diabetic patients, ultimately improving care management outcomes.

What is the most common primary diagnosis by age group?

Based on the hospital readmition data, the most common primary diagnosis by age group is as follows:

• For the age group [40-50), the most common primary diagnosis is "Other" with 750 cases.
• For the age group [50-60), the most common primary diagnosis is "Other" with 1164 cases.
• For the age group [60-70), the most common primary diagnosis is "Circulatory" with 1962 cases.
• For the age group [70-80), the most common primary diagnosis is "Circulatory" with 2392 cases.
• For the age group [80-90), the most common primary diagnosis is "Circulatory" with 1482 cases.
• For the age group [90-100), the most common primary diagnosis is "Circulatory" with 228 cases.

Thus, "Circulatory" conditions are the most common primary diagnosis among the older age groups ([60-70), [70-80), [80-90), [90-100)), while "Other" diagnoses are most common in the younger age groups ([40-50) and [50-60)).

Effects of Diabetes Diagnosis on Readmission Rates.

The data suggests that patients with diabetes as a primary diagnosis generally have higher readmission rates compared to those without diabetes, with the highest readmission rate observed in the [70-80) age group. However, when diabetes is listed as a secondary diagnosis, the readmission rates are generally lower across all age groups, indicating that diabetes as a secondary diagnosis might have a comparatively lesser impact on readmission rates. Nonetheless, further analysis is needed to understand the underlying factors contributing to these patterns.

Readmission for Diabetes as a Primary Diagnosis

The provided data presents the percentage of patients with diabetes across different age groups who were readmitted or not readmitted to the hospital. Analysis of the data reveals varying readmission rates across age groups. In the age range of 70-80, the highest percentage of patients (56.62%) with diabetes were readmitted, indicating a potential correlation between older age and increased likelihood of readmission. Conversely, in the age range of 60-70, although still relatively high, the readmission rate was slightly lower at 51.69%. Notably, the age groups 50-60 and 80-90 also exhibited relatively high readmission rates, suggesting that age may indeed play a significant role in diabetes-related hospital readmissions. Overall, the data underscores the importance of age-specific interventions and management strategies to mitigate hospital readmissions among diabetic patients.

Diabetes As A Secondary Diagnostic

Comparing the data for diabetes as a primary diagnostic to that of diabetes as a secondary diagnosis reveals interesting insights. While both datasets show higher readmission rates among older age groups, particularly in the 70-80 and 80-90 age ranges, there are notable differences in the magnitude of readmission percentages. In the primary diagnostic dataset, the readmission rates generally appear to be higher across all age groups, with percentages ranging from 51.69% to 56.62% in the highest readmission age group. Conversely, in the secondary diagnostic dataset, the readmission percentages are comparatively lower, with the highest rate recorded at 51.82% in the 80-90 age group. This suggests that the presence of diabetes as a primary diagnosis may be associated with a greater likelihood of hospital readmissions compared to when it is listed as a secondary diagnosis.