A hospital readmission is when a patient who was discharged from the hospital is admitted again for the same or related care within a certain period. Hospital readmissions are a significant problem in the healthcare domain, as they lead to increased hospitalization costs, decreased patient satisfaction, and increased risk of adverse outcomes such as infections, medication errors, and even death. The problem of hospital readmissions is particularly acute in intensive care units (ICUs), due to the severity of the patients' conditions, and the substantial risk of complications. Predicting Unplanned Readmissions in ICUs is a challenging task, as it involves analyzing different data modalities, such as static data, unstructured free text, sequences of diagnoses and procedures, and multivariate time-series. Here, we investigate the effectiveness of each data modality separately, then alongside with others, using state-of-the-art machine learning approaches in time-series analysis and natural language processing. Using our evaluation process, we are able to determine the contribution of each data modality, and for the first time in the context of readmission, establish a hierarchy of their predictive value. Additionally, we demonstrate the impact of Temporal Abstractions in enhancing the performance of time-series approaches to readmission prediction. Due to conflicting definitions in the literature, we also provide a clear definition of the term Unplanned Readmission to enhance reproducibility and consistency of future research and to prevent any potential misunderstandings that could result from diverse interpretations of the term. Our experimental results on a large benchmark clinical data set show that Discharge Notes written by physicians, have better capabilities for readmission prediction than all other modalities.

Risk scores are widely used for clinical decision making and commonly generated from logistic regression models. Machine-learning-based methods may work well for identifying important predictors, but such 'black box' variable selection limits interpretability, and variable importance evaluated from a single model can be biased. We propose a robust and interpretable variable selection approach using the recently developed Shapley variable importance cloud (ShapleyVIC) that accounts for variability across models. Our approach evaluates and visualizes overall variable contributions for in-depth inference and transparent variable selection, and filters out non-significant contributors to simplify model building steps. We derive an ensemble variable ranking from variable contributions, which is easily integrated with an automated and modularized risk score generator, AutoScore, for convenient implementation. In a study of early death or unplanned readmission, ShapleyVIC selected 6 of 41 candidate variables to create a well-performing model, which had similar performance to a 16-variable model from machine-learning-based ranking.

In 2019, The Centers for Medicare and Medicaid Services (CMS) launched an Artificial Intelligence (AI) Health Outcomes Challenge seeking solutions to predict risk in value-based care for incorporation into CMS Innovation Center payment and service delivery models. Recently, modern language models have played key roles in a number of health related tasks. This paper presents, to the best of our knowledge, the first application of these models to patient readmission prediction. To facilitate this, we create a dataset of 1.2 million medical history samples derived from the Limited Dataset (LDS) issued by CMS. Moreover, we propose a comprehensive modeling solution centered on a deep learning framework for this data. To demonstrate the framework, we train an attention-based Transformer to learn Medicare semantics in support of performing downstream prediction tasks thereby achieving 0.91 AUC and 0.91 recall on readmission classification. We also introduce a novel data pre-processing pipeline and discuss pertinent deployment considerations surrounding model explainability and bias.

There is a common myth that heart disease is more of a problem for men than women, however women and men die at equal rates from heart disease. Studies have shown that men's heart health is more researched and prioritized over women's heart health which creates an issue in diagnostics. Misdiagnosis or under diagnosis plague women with hidden heart issues and they won't always get the treatment they need. Because of this irritating and unethical issue, cardiologist and researcher, Dr. Amod Amritphale is working to change this outcome of heart health in women. Symptoms of heart disease in women are very different than men, but the warning signs for men are published more in the media and are known to be more obvious than for women.

Deep learning techniques have been successfully applied to predict unplanned readmissions of patients in medical centers. The training data for these models is usually based on historical medical records that contain a significant amount of free-text from admission reports, referrals, exam notes, etc. Most of the models proposed so far are tailored to English text data and assume that electronic medical records follow standards common in developed countries. These two characteristics make them difficult to apply in developing countries that do not necessarily follow international standards for registering patient information, or that store text information in languages other than English. In this paper we propose a deep learning architecture for predicting unplanned readmissions that consumes data that is significantly less structured compared with previous models in the literature. We use it to present the first results for this task in a large clinical dataset that mainly contains Spanish text data. The dataset is composed of almost 10 years of records in a Chilean medical center. On this dataset, our model achieves results that are comparable to some of the most recent results obtained in US medical centers for the same task (0.76 AUROC).

We develop a model using deep learning techniques and natural language processing on unstructured text from medical records to predict hospital-wide $30$-day unplanned readmission, with c-statistic $.70$. Our model is constructed to allow physicians to interpret the significant features for prediction.