High hospital readmission rates are associated with significant costs and health risks for patients. Therefore, it is critical to develop predictive models that can support clinicians to determine whether or not a patient will return to the hospital in a relatively short period of time (e.g, 30-days). Nowadays, it is possible to collect both structured (electronic health records - EHR) and unstructured information (clinical notes) about a patient hospital event, all potentially containing relevant information for a predictive model. However, their integration is challenging. In this work we explore the combination of clinical notes and EHRs to predict 30-day hospital readmissions. We address the representation of the various types of information available in the EHR data, as well as exploring LLMs to characterize the clinical notes. We collect both information sources as the nodes of a graph neural network (GNN). Our model achieves an AUROC of 0.72 and a balanced accuracy of 66.7\%, highlighting the importance of combining the multimodal information.

Readmissions among Medicare beneficiaries are a major problem for the US healthcare system from a perspective of both healthcare operations and patient caregiving outcomes. Our study analyzes Medicare hospital readmissions using LSTM networks with feature engineering to assess feature contributions. We selected variables from admission-level data, inpatient medical history and patient demography. The LSTM model is designed to capture temporal dynamics from admission-level and patient-level data. On a case study on the MIMIC dataset, the LSTM model outperformed the logistic regression baseline, accurately leveraging temporal features to predict readmission. The major features were the Charlson Comorbidity Index, hospital length of stay, the hospital admissions over the past 6 months, while demographic variables were less impactful. This work suggests that LSTM networks offers a more promising approach to improve Medicare patient readmission prediction. It captures temporal interactions in patient databases, enhancing current prediction models for healthcare providers. Adoption of predictive models into clinical practice may be more effective in identifying Medicare patients to provide early and targeted interventions to improve patient outcomes.

The work is made available under the Creative Commons CC0 public domain dedication. Data Availability: Data are publicly available from the Agency for Healthcare Research and Quality. They may be obtained through a data use agreement with the following site: https://www.hcup-us.ahrq.gov/nrdoverview.jsp. The statistical code are freely available with a link provided in the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.