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AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
Clustering-AidedApproachfor Predicting
Patient Outcomeswith Applicationto Elderly
Healthcarein Ireland
Mahmoud Elbattah, Owen Molloy
mahmoud.elbattah@nuigalway.ie
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
Challengeto Healthcare: PopulationAgeing
2Source : Health Service Executive. Annual Report and Financial Statements, 2014.
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
Our Focus: Hip FractureCare in Ireland
• A good exemplar of elderly healthcare.
• Exponentially increasing with age.1
• Identified as one of the most serious injuries resulting in
lengthy hospital admissions and high costs.2
• High quality data available through the Irish Hip Fracture
Database (IHFD).
3
Sources :1 Gullberg, B., Johnell, O. and Kanis, J.A., 1997. World-wide projections for hip fracture. Osteoporosis international, 7(5), pp.407-413.
2http://www.hse.ie/eng/services/publications/olderpeople/Executive_Summary_Strategy_to_Prevent_Falls_and_Fractures_in_Ireland%E2%80%99s_Ageing_Po
pulation.pdf
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
Overview:Hip FractureCare Scheme
4
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
Objectives
• To predict the inpatient length of stay (LOS).
• To predict the patient’s discharge destination.
5
Importance of Predicting LOS and Discharge
Destination
LOS:
• A significant measure of
patient outcomes [1-3].
• A valid proxy to measure the
consumption of hospital
resources.
• Reported as the main
component of the overall cost
of hip fracture care [4].
Discharge Destination:
• Having a strategic importance
to estimate the needed capacity
of long-stay care facilities such
as nursing homes.
6
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
Approach Overview
7
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
Data Description
• Irish Hip Fracture Database (IHFD).
• Patient records in the years 2013-2014.
• Patients aged 60 and over.
• 38 data fields such as gender, age, type of fracture, date
of admission, and LOS.
8
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
K-MeansClusteringExperiments
9
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
LearningAlgorithm: Random Forests
10
𝑝 𝑐 𝑣 =
1
𝑇
෍
𝑡=1
𝑇
𝑝𝑡(𝑐|𝑣)
, where pt(c|v) denotes the posterior distribution obtained by the t-th
tree.
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
LearningAlgorithm: Random Forests
Source: https://scholar.google.com/citations?user=mXSv_1UAAAAj
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
PayingTributeto Leo Breiman(1928-2005)
12
Feature Selection & Extraction
LOS Regression Model:
• Age
• Patient Gender
• Fracture Type
• HospitalAdmitted To
• ICD-10 Diagnosis
• Fragility History
• Time to Surgery
Discharge Destination
Classifier:
• Age
• Patient Gender
• Fracture Type
• Hospital Admitted To
• ICD-10 Diagnosis
• LOS
• Fragility History
• Time to Surgery
13
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
ExperimentalResults:
RegressionAccuracy(10-Fold Cross-Validation)
14
LOS Predictors Relative Absolute
Error (≈)
Relative Squared
Error (≈)
Coefficient of
Determination (≈)
Cluster 1 0.24 0.14 0.86
Cluster 2 0.30 0.19 0.81
Cluster 3 0.28 0.18 0.82
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
ExperimentalResults:
ClassifierAccuracy(10-Fold Cross-Validation)
15
Cluster1 Cluster2 Cluster3
AUC=0.851 AUC=0.739 AUC=0.863
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
The Significanceof Clustering
16
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
The Significanceof Clustering(cont’d)
17
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
The Significanceof Clustering(cont’d)
18
* The features were decided based on the permutation importance method [5]
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
More about Patient Clustering…
19
https://dl.acm.org/citation.cfm?id=3014874
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
ClosingThought
• “The key challenges facing healthcare providers in future
years are perhaps more organisational and logistical than
medical and scientific advances”.
(Sally Brailsford & Jan Vissers 2011)
20
Source :Brailsford, S. and Vissers, J., 2011. OR in healthcare: A European perspective. European journal of operational research, 212(2),
pp.223-234.
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
References
1. O'Keefe, G.E., Jurkovich, G.J. and Maier, R.V., 1999. Defining excess resource
utilization and identifying associated factors for trauma victims. Journal of Trauma
and Acute Care Surgery, 46(3), pp.473-478.
2. Englert, J., Davis, K.M. and Koch, K.E., 2001. Using clinical practice analysis to
improve care. Joint Commission Journal on Quality and Patient Safety, 27(6),
pp.291-301.
3. Guru, V., Anderson, G.M., Fremes, S.E., O’Connor, G.T., Grover, F.L., Tu, J.V. and
Consensus, C.C.S.Q.I., 2005. The identification and development of Canadian
coronary artery bypass graft surgery quality indicators. The Journal of thoracic and
cardiovascular surgery, 130(5), pp.1257-e1.
4. Johansen, A., Wakeman, R., Boulton, C., Plant, F., Roberts, J. and Williams, A.,
2013. National Hip Fracture Database: National Report 2013. Clinical Effectiveness
and Evaluation Unit at the Royal College of Physicians.
5. Altmann, A., Toloşi, L., Sander, O. and Lengauer, T., 2010. Permutation importance:
a corrected feature importance measure. Bioinformatics, 26(10), pp.1340-1347.
6. Breiman, L., 2001. Random forests. Machine learning, 45(1), pp.5-32.
7. Brailsford, S. and Vissers, J., 2011. OR in healthcare: A European
perspective. European journal of operational research, 212(2), pp.223-234.
21
AAAI 2017-Workshop on Health Intelligence (W3PHIAI)
THANK YOU!
mahmoud.elbattah@nuigalway.ie

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Clustering-Aided Approach for Predicting Patient Outcomes with Application to Elderly Healthcare in Ireland

  • 1. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) Clustering-AidedApproachfor Predicting Patient Outcomeswith Applicationto Elderly Healthcarein Ireland Mahmoud Elbattah, Owen Molloy mahmoud.elbattah@nuigalway.ie
  • 2. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) Challengeto Healthcare: PopulationAgeing 2Source : Health Service Executive. Annual Report and Financial Statements, 2014.
  • 3. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) Our Focus: Hip FractureCare in Ireland • A good exemplar of elderly healthcare. • Exponentially increasing with age.1 • Identified as one of the most serious injuries resulting in lengthy hospital admissions and high costs.2 • High quality data available through the Irish Hip Fracture Database (IHFD). 3 Sources :1 Gullberg, B., Johnell, O. and Kanis, J.A., 1997. World-wide projections for hip fracture. Osteoporosis international, 7(5), pp.407-413. 2http://www.hse.ie/eng/services/publications/olderpeople/Executive_Summary_Strategy_to_Prevent_Falls_and_Fractures_in_Ireland%E2%80%99s_Ageing_Po pulation.pdf
  • 4. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) Overview:Hip FractureCare Scheme 4
  • 5. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) Objectives • To predict the inpatient length of stay (LOS). • To predict the patient’s discharge destination. 5
  • 6. Importance of Predicting LOS and Discharge Destination LOS: • A significant measure of patient outcomes [1-3]. • A valid proxy to measure the consumption of hospital resources. • Reported as the main component of the overall cost of hip fracture care [4]. Discharge Destination: • Having a strategic importance to estimate the needed capacity of long-stay care facilities such as nursing homes. 6
  • 7. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) Approach Overview 7
  • 8. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) Data Description • Irish Hip Fracture Database (IHFD). • Patient records in the years 2013-2014. • Patients aged 60 and over. • 38 data fields such as gender, age, type of fracture, date of admission, and LOS. 8
  • 9. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) K-MeansClusteringExperiments 9
  • 10. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) LearningAlgorithm: Random Forests 10 𝑝 𝑐 𝑣 = 1 𝑇 ෍ 𝑡=1 𝑇 𝑝𝑡(𝑐|𝑣) , where pt(c|v) denotes the posterior distribution obtained by the t-th tree.
  • 11. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) LearningAlgorithm: Random Forests Source: https://scholar.google.com/citations?user=mXSv_1UAAAAj
  • 12. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) PayingTributeto Leo Breiman(1928-2005) 12
  • 13. Feature Selection & Extraction LOS Regression Model: • Age • Patient Gender • Fracture Type • HospitalAdmitted To • ICD-10 Diagnosis • Fragility History • Time to Surgery Discharge Destination Classifier: • Age • Patient Gender • Fracture Type • Hospital Admitted To • ICD-10 Diagnosis • LOS • Fragility History • Time to Surgery 13
  • 14. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) ExperimentalResults: RegressionAccuracy(10-Fold Cross-Validation) 14 LOS Predictors Relative Absolute Error (≈) Relative Squared Error (≈) Coefficient of Determination (≈) Cluster 1 0.24 0.14 0.86 Cluster 2 0.30 0.19 0.81 Cluster 3 0.28 0.18 0.82
  • 15. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) ExperimentalResults: ClassifierAccuracy(10-Fold Cross-Validation) 15 Cluster1 Cluster2 Cluster3 AUC=0.851 AUC=0.739 AUC=0.863
  • 16. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) The Significanceof Clustering 16
  • 17. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) The Significanceof Clustering(cont’d) 17
  • 18. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) The Significanceof Clustering(cont’d) 18 * The features were decided based on the permutation importance method [5]
  • 19. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) More about Patient Clustering… 19 https://dl.acm.org/citation.cfm?id=3014874
  • 20. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) ClosingThought • “The key challenges facing healthcare providers in future years are perhaps more organisational and logistical than medical and scientific advances”. (Sally Brailsford & Jan Vissers 2011) 20 Source :Brailsford, S. and Vissers, J., 2011. OR in healthcare: A European perspective. European journal of operational research, 212(2), pp.223-234.
  • 21. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) References 1. O'Keefe, G.E., Jurkovich, G.J. and Maier, R.V., 1999. Defining excess resource utilization and identifying associated factors for trauma victims. Journal of Trauma and Acute Care Surgery, 46(3), pp.473-478. 2. Englert, J., Davis, K.M. and Koch, K.E., 2001. Using clinical practice analysis to improve care. Joint Commission Journal on Quality and Patient Safety, 27(6), pp.291-301. 3. Guru, V., Anderson, G.M., Fremes, S.E., O’Connor, G.T., Grover, F.L., Tu, J.V. and Consensus, C.C.S.Q.I., 2005. The identification and development of Canadian coronary artery bypass graft surgery quality indicators. The Journal of thoracic and cardiovascular surgery, 130(5), pp.1257-e1. 4. Johansen, A., Wakeman, R., Boulton, C., Plant, F., Roberts, J. and Williams, A., 2013. National Hip Fracture Database: National Report 2013. Clinical Effectiveness and Evaluation Unit at the Royal College of Physicians. 5. Altmann, A., Toloşi, L., Sander, O. and Lengauer, T., 2010. Permutation importance: a corrected feature importance measure. Bioinformatics, 26(10), pp.1340-1347. 6. Breiman, L., 2001. Random forests. Machine learning, 45(1), pp.5-32. 7. Brailsford, S. and Vissers, J., 2011. OR in healthcare: A European perspective. European journal of operational research, 212(2), pp.223-234. 21
  • 22. AAAI 2017-Workshop on Health Intelligence (W3PHIAI) THANK YOU! mahmoud.elbattah@nuigalway.ie