Journal Article

An AI-driven clinical care pathway to reduce 30-day readmission for chronic obstructive pulmonary disease (COPD) patients

Ezeana, Chika F., Roberts, Aaron W., Nezamabadi, Aryan, Xu, Pingyi, Wong, Solomon S. Y., Wong, Stephen T. C., Li, Guihua, Jackson, Robert E., Yin, Zheng, He, Tiancheng, Puppala, Mamta, Wang, Lin, Yu, Xiaohui, Frost, Adaani, Ogunti, Richard

2022

Overview

Healthcare regulatory agencies have mandated a reduction in 30-day hospital readmission rates and have targeted COPD as a major contributor to 30-day readmissions. We aimed to develop and validate a simple tool deploying an artificial neural network (ANN) for early identification of COPD patients with high readmission risk. Using COPD patient data from eight hospitals within a large urban hospital system, four variables were identified, weighted and validated. These included the number of in-patient admissions in the previous 6 months, the number of medications administered on the first day, insurance status, and the Rothman Index on hospital day one. An ANN model was trained to provide a predictive algorithm and validated on an additional dataset from a separate time period. The model was implemented in a smartphone app (Re-Admit) incorporating four input risk factors, and a clinical care plan focused on high-risk readmission candidates was then implemented. Subsequent readmission data was analyzed to assess impact. The areas under the curve of receiver operating characteristics predicting readmission with ANN is 0.77, with sensitivity 0.75 and specificity 0.67 on the separate validation data. Readmission rates in the COPD high-risk subgroup after app and clinical intervention implementation saw a significant 48% decline. Our studies show the efficacy of ANN model on predicting readmission risks for COPD patients. The AI enabled Re-Admit smartphone app predicts readmission risk on day one of the patient’s admission, allowing for early implementation of medical, hospital, and community resources to optimize and improve clinical care pathways.

• Publisher: Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
• Subject: 692/499 / 692/699/1785/4037 / 692/700/228 / 692/700/459 / Chronic obstructive pulmonary disease / Critical Pathways / Hospitals, Urban / Humanities and Social Sciences / Humans / Lung diseases / multidisciplinary / Neural networks / Neural Networks, Computer / Obstructive lung disease / Patient Readmission / Patients / Pulmonary Disease, Chronic Obstructive - therapy / Risk factors / Risk groups / Science / Science (multidisciplinary) / Smartphones