personalization of surgeries the tool for minimizing the number of readmissions to hospitals and...

Personalization of SurgeriesThe tool for minimizing the number of readmissions

to hospitals and patient safety

Zbigniew W. RasCollege of Computing and Informatics, UNC-Charlotte

& James Studnicki

College of Health and Human Services, UNC-Charlotte

22

1. Failures of care delivery2. Failures of care coordination3. Overtreatment4. Administrative complexity5. Pricing failures6. Fraud and abuse7. Readmissions & - our area Patient Safety of research

1Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012;307(14):E1-E4.2Lowe TJ, Partovian C, Kroch E, Martin J, Bankowitz R. Measuring cardiac waste: the Premier Cardiac Waste Measures. Am J Med Qual. 2013 May 29, DOI: 10.1177/1062860613487923.

Primary Areas of Healthcare Waste Research1

PREMIER primary area of research2

3

We focus on:

- decreasing the number of readmissions to hospitals caused by side effects

- improving patient safety

Expected outcome:

- significant reduction of the cost

4

Florida State Inpatient Databases (SID), part of the Healthcare Cost and Utilization

Project (HCUP)

• A total of over 2.5 million visit discharges from 1.5 million patients

• Patients are diagnosed with a maximum of 31 diagnostic codes.

• Demographic data: age, gender, race,……..

5

Patient has 7 diagnosticcodes discovered by doctor

Where is the problem?

Surgery(i) is recommended because ofthese 3 (marked) diagnostic codes

Surgery(i)Surgery successful??

Patient readmitted to the hospital because of the side effects caused by surgery

New diagnostic codes

15 readmissions – worst caseAverage – between 5 and 6

66

All patients in SID databasehaving d1,d2,d3 diagnostic codes assigned to them.


Surgery(i) is recommended because ofd1,d2,d3 diagnostic codes

Surgery(i)

d1,d2,d3

{d1,d2,d3} -> empty set

{d1,d2,d3} -> {d1,d3}

{d1,d2,d3} -> {d1,d3,d5}

{d1,d2,d3} -> {d1, d5,d6}

{d1,d2,d3} -> {d5,d7}

Personalized Surgeries(up to 300 per surgery)

We partitioned all patients having Surgery(i)Into clusters: 2 patients are in the same clusterif they confirm the same rule.

Rules

777

All patients in SID databasehaving all 7 diagnostic codes assigned to them.



Surgery(i)

d1,d2,d3d4,d5,d6,d7

{d1,d2,d3} -> empty set

{d1,d2,d3} -> {d1,d3}

{d1,d2,d3} -> {d1,d3,s5}

{d1,d2,d3} -> {d1, s5,s6}

{d1,d2,d3} -> {s5,s7}


s5 – listed in ALL personalized surgeriesWe should take care of s5 during Surgery(i)To take care of s5 may require additional personalized surgery which may cause new side effects

Much smaller DB

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--------------------------------------------------------------------------------------------------------------Patient ID Visit-Number Main-Procedure-Code Set-of-Diagnoses-Codes--------------------------------------------------------------------------------------------------------------1 1 11 {11, 20, 234}1 2 44 {11, 234}1 3 98 {22,

234}--------------------------------------------------------------------------------------------------------------2 1 44 {11, 34, 99}2 2 122 {4; 34}--------------------------------------------------------------------------------------------------------------3 1 44 {11, 20, 44, 101} 3 2 92 {20, 44, 4}3 3 122 {4, 34}--------------------------------------------------------------------------------------------------------------4 1 11 {11, 22, 89}4 2 44 {11, 234, 89}4 3 122 {11, 22,

89}--------------------------------------------------------------------------------------------------------------

Red color – Negative side effect ; Green - Neutral ; Black color - positive

99 99


Assume that d4 – hyperthyroid and without d4 personalized surgeries are much safer and haveless number of side effects. It means d4 has tobe fixed first.

Quite interesting?


Surgery(i)

d1,d2,d3d4,d5,d6,d7

Surgery unsuccessful

{d1,d2,d3} -> {s5,s6}

{d1,d2,d3} -> {d1,d3,s5}

{d1,d2,d3} -> {d1, s5,s6}

{d1,d2,d3} -> {s5,s7}


d4

1010101010


Assume that d8 – high blood pressure and with d8 added to {d1,d2,d3,d4,d5,d6,d7} personalized surgeries are much safer and have less number of side effects. It means d8 has to be invoked before Surgery(i) takes place.

Quite surprising?


Surgery(i)

d1,d2,d3d4,d5,d6,d7


{d1,d2,d3} -> {s5,s6}

{d1,d2,d3} -> {d1,d3,s5}

{d1,d2,d3} -> {d1, s5,s6}

{d1,d2,d3} -> {s5,s7}


d4 d8

111111111111


Assume that d8 – high blood pressure and with d8 added to {d1,d2,d3,d4,d5,d6,d7} personalized surgeries are much safer and have less number of side effects. It means d8 has to be invoked before Surgery(i) takes place.Maybe d4 should fixed first?

What we have done wrong?


Surgery(i)

d1,d2,d3d4,d5,d6,d7


d4 d8

121212

Surgery(i)Surgery(i3)

Surgery(i2) Surgery(i6)

Passed Away

50

500

200

10

10

30

20

D1

D2

Split 500 patients using all stable features (not comorbid conditions) using minimal average entropy approach. Repeat this step for all surgeries.The trees defining different levels of personalization will differ but the same attributes will be used on the lowest level of these trees.

Use J48 (WEKA) on all stable attributes to split

Use J48 (WEKA) on all stable attributes to split

1313

Surgery(i)

Surgery(i5)

Surgery(i4)

Surgery(i3)

Surgery(i2)

Surgery(i8)

Surgery(i7)

Surgery(i6)

Passed Away

Passed Away

50

500

50

200

10

10

30

150

50

20

150

20

Passed Away

10

Probability of thepath: 2/5 * 3/4

cost, length of stay, …, side effects

D1

D2

D3

D4D5

Assume that Surgery(i), Surgery(i2), Surgery(i6) is the optimal path

1414

Surgery(i)Surgery(i3)

Surgery(i2)

Surgery(i7)

Surgery(i6)

50

500200

10

30

150

20

D1

D2

We would like to move 200 patients following the path Surgery(i), D2 to Surgery(i), D1.

P1 P2 P3 P4 D

pat1 X X X D2

pat2 X X X D2

pat3 X X X D2

pat200 X X X D2

pat201 X X D1

pat250 X X X D1

Diagnostic Codes(Diagnoses)

p1.p2.p3 -> p1.p2p1.p3.p4 -> p1.p2

Placing patients on a different path

Questions ?

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personalization of surgeries the tool for minimizing the number of readmissions to hospitals and...

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