Abstract
Purpose
Analyzing the risk of re-hospitalization of patients with chronic diseases allows the healthcare institutions can deliver accurate preventive care to reduce hospital admissions, and the planning of the medical spaces and resources. Thus, the research question is: Is it possible to use artificial intelligence to study the risk of re-hospitalization of patients?
Methods
This article presents several models to predict when a patient can be hospitalized again, after its discharge. In addition, an explainability analysis is carried out with the predictive models to extract information to determine the degree of importance of the predictors/descriptors. Particularly, this article makes a comparative analysis of different explainability techniques in the study context.
Results
The best model is a classifier based on decision trees with an F1-Score of 83% followed by LGMB with an F1-Score of 67%. For these models, Shapley values were calculated as a method of explainability. Concerning the quality of the explainability of the predictive models, the stability metric was used. According to this metric, more variability is evidenced in the explanations of the decision trees, where only 4 attributes are very stable (21%) and 1 attribute is unstable. With respect to the LGBM-based model, there are 12 stable attributes (63%) and no unstable attributes. Thus, in terms of explainability, the LGBM-based model is better.
Conclusions
According to the results of the explanations generated by the best predictive models, LGBM-based predictive model presents more stable variables. Thus, it generates greater confidence in the explanations it provides.
Similar content being viewed by others
Data availability
The datasets used in the current study are available from the corresponding author on reasonable request.
References
Jencks S, Williams N, Coleman E. Rehospitalizations among patients in the Medicare fee-for-service. N Engl J Med. 2009;360:1418–28.
Kansagara D. Risk prediction models for hospital readmission, a systematic review. JAMA. 2011;306(15):1688–98.
Insight D. 56% of hospitals lack big data governance. Analytics plans, health IT analytics [Online]. 2017. Available https://healthitanalytics.com/news/56-of-hospitals-lack-big-data-governance-analytics-plans.
Jaana J. The diabetes risk score: A practical tool to predict type 2 diabetes risk. Expert Syst Appl. 2003;26(3):725–31.
Ortiz M, Altamar Z, Martínez C, Petrillo A, Jiménez G, García A, Medina A. Predicting 15-day unplanned readmissions in hospitalization departments: an application of logistic regression. Ingeniare Revista Chilena de Ingeniería. 2021;29(2):378–98.
Michailidis P, Dimitriadou A, Papadimitriou T, Gogas P. Forecasting hospital readmissions with machine learning. Healthcare. 2022;10:981.
Zhang D, Lee J. Effective hospital readmission prediction models using machine-learned features. BMC Health Serv Res. 2022;22:1415.
Arkaitz G. Predictive models for hospital readmission risk: A systematic review of methods. Comput Methods Programs Biomed. 2018;164:49–64.
Hoyos W, Aguilar J, Toro M. Dengue models based on machine learning techniques: A systematic literature review. Artif Intell Med. 2021;119:102157. https://doi.org/10.1016/j.artmed.2021.102157.
Quintero Y, Ardila D, Camargo E, Rivas F, Aguila J. Machine learning models for the prediction of the SEIRD variables for the COVID-19 pandemic based on a deep dependence analysis of variables. Comput Biol Med. 2021;134:104500. https://doi.org/10.1016/j.compbiomed.2021.104500.
Camargo E, Aguilar J, Quintero Y, Rivas F, Ardila D. An incremental learning approach to prediction models of SEIRD variables in the context of the COVID-19 pandemic. Health Technol. 2022;12:867–77.
Holzinger A, Langs G, Denk H, Zatloukal K, Müller H. Causability and explainability of artificial intelligence in medicine. Wiley Interdiscip Rev Data Min Knowl Discov. 2019;4(9):e1312. https://doi.org/10.1002/widm.1312.
Burkart N, Huber M. A survey on the explainability of supervised machine learning. J Artif Intell Res. 2021;70:245–317.
Marco R, Sameer S, Carlos G. Why should i trust you? Explaining the predictions of any classifier. In: International conference on knowledge discovery and data mining. 2016.
Baig M, Hua N, Zhang E, Reece R, Spyker A, Armstrong D, Whittaker R, Robinson T, Ullah E. A machine learning model for predicting risk of hospital readmission within 30 days of discharge: validated with LACE index and patient at risk of hospital readmission (PARR) model. Med Biol Eng Comput. 2020;58:1459–66.
Lo YT, Liao JC, Chen MH, Chang C, Li C. Predictive modeling for 14-day unplanned hospital readmission risk by using machine learning algorithms. BMC Med Inform Decis Mak. 2021;21:288. https://doi.org/10.1186/s12911-021-01639-y.
Ko M, Chen E, Agrawal A, Rajpurkar P, Avati A, Ng A, Basu S, Shah N. Improving hospital readmission prediction using individualized utility analysis. J Biomed Inform. 2021;119:103826. https://doi.org/10.1016/j.jbi.2021.103826.
Zhao P, Yoo I, Naqvi SH. Early prediction of unplanned 30-day hospital readmission: model development and retrospective data analysis. JMIR Med Inform. 2021;23(9):e16306. https://doi.org/10.2196/16306. PMID: 33755027; PMCID: PMC8077543.
Afrash M, Kazemi-Arpanahi H, Shanbehzadeh M, Nopour R, Mirbagheri E. Predicting hospital readmission risk in patients with COVID-19: a machine learning approach. Inform Med Unlocked. 2022;30:100908. https://doi.org/10.1016/j.imu.2022.100908.
Shang Y, Jiang K, Wang L, Zhang Z, Zhou S, Liu Y, Dong J, Wu H. The 30-days hospital readmission risk in diabetic patients: predictive modeling with machine learning classifiers. BMC Med Inform Decis Mak. 2021;21:57. https://doi.org/10.1186/s12911-021-01423-y.
Huang Y, Talwar A, Chatterjee S, Aparasu R. Application of machine learning in predicting hospital readmissions: a scoping review of the literature. BMC Med Res Methodol. 2021;21:96. https://doi.org/10.1186/s12874-021-01284-z.
Gatt M, Cassar M, Buttigieg S. A review of literature on risk prediction tools for hospital readmissions in older adults. J Health Organ Manag. 2022;36(4):521–57.
Araujo M, Aguilar J, Aponte H. Fault detection system in gas lift well based on artificial immune system. In: Proc. International Joint Conference on Neural Networks, vol. 3. 2003. p. 1673–7.
Aguilar J, Jerez M, Exposito E, Villemur T. CARMiCLOC: context awareness middleware in cloud computing. In Latin American Computing Conference (CLEI). 2015
Morales L, Ouedraogo C, Aguilar J, Chassot C, Medjiah S, Drira K. Experimental comparison of the diagnostic capabilities of classification and clusteri algorithms for the QoS management in an autonomic IoT platform. SOCA. 2019;13:199–219.
Sánchez M, Aguilar J, Cordero C, Valdiviezo-Díaz P, Barba-Guamán L, Chamba-Eras L. Cloud computing in smart educational environments: application in learning analytics as service. In: Rocha Á, Correia A, Adeli H, Reis L, Teixeira MM, editors. New advances in information systems and technologies. Advances in intelligent systems and computing. 2016. p. 444.
Unión Europea. Reglamento (UE) 2016/679 del Parlamento Europeo y del Consejo [Online]. Madrid; 2016. Available https://www.boe.es/doue/2016/119/L00001-00088.pdf.
Molnar C. Interpretable machine learning. A guide for making black box models explainable. Leanpub. 2019.
Ribeiro M, Singh S, Guestrin C. Model-agnostic interpretability of machine learning. Chapter 6. In: Molnar C, editor. Interpretable machine learning: a guide for making black box models explainable. Independently published. 2022.
Shearer C. The CRISP-DM model: The new blueprint for data mining. J Data Warehous. 2000;5:13–22.
Anonymous database. https://www.epssura.com/.
Breiman A. Classification and regression trees. New York; 1984.
Breiman L. Statistical modeling: The two cultures (with comments and a rejoinder by the author). Stat Sci. 2001;16(3):199–231.
Freund Y, Schapire R. A decision-theoretic generalization of on-line learning and an application to boosting. J Comput Syst Sci. 1997;55(1):119–39.
Ledoit O, Wolf M, Honey I. Shrunk the sample covariance matrix. J Portf Manag. 2004;30:110–9.
Hoyos W, Aguilar J, Toro M. A clinical decision-support system for dengue based on fuzzy cognitive maps. Health Care Manag Sci. 2022;25:666–81.
Vizcarrondo J, Aguilar J, Exposito E, Subias A. ARMISCOM: Autonomic reflective middleware for management service composition. In: Global Information Infrastructure and Networking Symposium (GIIS). 2012.
Funding
Jose Aguilar was partially supported by grant 22-STIC-06 (HAMADI 4.0 project) funded by the STIC-AmSud regional program.
Author information
Authors and Affiliations
Contributions
Concept and design: All authors; Acquisition, analysis, or interpretation of data: Lopera; Drafting of the manuscript: All authors; Results analysis: All authors; Obtained funding: Aguilar.
Corresponding author
Ethics declarations
Ethics statement
The study was conducted in accordance with relevant guidelines and regulations, and approved by the EAFIT University ethics committee.
Consent to participate
The Sura health center has signed an anonymized data use agreement with the EAFIT University.
Competing interests
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Bedoya, J.C.L., Castro, J.L.A. Explainability analysis in predictive models based on machine learning techniques on the risk of hospital readmissions. Health Technol. 14, 93–108 (2024). https://doi.org/10.1007/s12553-023-00794-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12553-023-00794-8