Machine learning approaches for early DRG classification and resource allocation

Recent research has highlighted the need for upstream planning in healthcare service delivery systems, patient scheduling, and resource allocation in the hospital inpatient setting. This study examines the value of upstream planning within hospital-wide resource allocation decisions based on machine learning (ML) and mixed-integer programming (MIP), focusing on prediction of diagnosis-related groups (DRGs) and the use of these predictions for allocating scarce hospital resources. DRGs are a payment scheme employed at patients’ discharge, where the DRG and length of stay determine the revenue that the hospital obtains. We show that early and accurate DRG classification using ML methods, incorporated into an MIP-based resource allocation model, can increase the hospital’s contribution margin, the number of admitted patients, and the utilization of resources such as operating rooms and beds. We test these methods on hospital data containing more than 16,000 inpatient records and demonstrate improved DRG classification accuracy as compared to the hospital’s current approach. The largest improvements were observed at and before admission, when information such as procedures and diagnoses is typically incomplete, but performance was improved even after a substantial portion of the patient’s length of stay, and under multiple scenarios making different assumptions about the available information. Using the improved DRG predictions within our resource allocation model improves contribution margin by 2.9% and the utilization of scarce resources such as operating rooms and beds from 66.3% to 67.3% and from 70.7% to 71.7%, respectively. This enables 9.0% more nonurgent elective patients to be admitted as compared to the baseline

Artificial Intelligence Techniques That May Be Applied to Primary Care Data to Facilitate Earlier Diagnosis of Cancer: Systematic Review.

BACKGROUND: More than 17 million people worldwide, including 360,000 people in the United Kingdom, were diagnosed with cancer in 2018. Cancer prognosis and disease burden are highly dependent on the disease stage at diagnosis. Most people diagnosed with cancer first present in primary care settings, where improved assessment of the (often vague) presenting symptoms of cancer could lead to earlier detection and improved outcomes for patients. There is accumulating evidence that artificial intelligence (AI) can assist clinicians in making better clinical decisions in some areas of health care. OBJECTIVE: This study aimed to systematically review AI techniques that may facilitate earlier diagnosis of cancer and could be applied to primary care electronic health record (EHR) data. The quality of the evidence, the phase of development the AI techniques have reached, the gaps that exist in the evidence, and the potential for use in primary care were evaluated. METHODS: We searched MEDLINE, Embase, SCOPUS, and Web of Science databases from January 01, 2000, to June 11, 2019, and included all studies providing evidence for the accuracy or effectiveness of applying AI techniques for the early detection of cancer, which may be applicable to primary care EHRs. We included all study designs in all settings and languages. These searches were extended through a scoping review of AI-based commercial technologies. The main outcomes assessed were measures of diagnostic accuracy for cancer. RESULTS: We identified 10,456 studies; 16 studies met the inclusion criteria, representing the data of 3,862,910 patients. A total of 13 studies described the initial development and testing of AI algorithms, and 3 studies described the validation of an AI algorithm in independent data sets. One study was based on prospectively collected data; only 3 studies were based on primary care data. We found no data on implementation barriers or cost-effectiveness. Risk of bias assessment highlighted a wide range of study quality. The additional scoping review of commercial AI technologies identified 21 technologies, only 1 meeting our inclusion criteria. Meta-analysis was not undertaken because of the heterogeneity of AI modalities, data set characteristics, and outcome measures. CONCLUSIONS: AI techniques have been applied to EHR-type data to facilitate early diagnosis of cancer, but their use in primary care settings is still at an early stage of maturity. Further evidence is needed on their performance using primary care data, implementation barriers, and cost-effectiveness before widespread adoption into routine primary care clinical practice can be recommended.CRU

Artificial Intelligence Techniques That May Be Applied to Primary Care Data to Facilitate Earlier Diagnosis of Cancer : Systematic Review

Acknowledgments This research was funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Cancer Awareness, Screening, and Early Diagnosis, PR-PRU-1217-21601. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. This work was also supported by the CanTest Collaborative (funded by Cancer Research UK C8640/A23385), of which FW and WH are directors and JE, HS, and NdW are associate directors. HS is additionally supported by the Houston Veterans Administration Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety (CIN13-413) and the Agency for Healthcare Research and Quality (R01HS27363). The funding sources had no role in the study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit for publication. The authors would like to thank Isla Kuhn, Reader Services Librarian, University of Cambridge Medical Library, for her help in developing the search strategy.Peer reviewedPublisher PD

Improving sample and feature selection with principal covariates regression

Funder: Trinity College, University of Cambridge; doi: http://dx.doi.org/10.13039/501100000727Abstract: Selecting the most relevant features and samples out of a large set of candidates is a task that occurs very often in the context of automated data analysis, where it improves the computational performance and often the transferability of a model. Here we focus on two popular subselection schemes applied to this end: CUR decomposition, derived from a low-rank approximation of the feature matrix, and farthest point sampling (FPS), which relies on the iterative identification of the most diverse samples and discriminating features. We modify these unsupervised approaches, incorporating a supervised component following the same spirit as the principal covariates (PCov) regression method. We show how this results in selections that perform better in supervised tasks, demonstrating with models of increasing complexity, from ridge regression to kernel ridge regression and finally feed-forward neural networks. We also present adjustments to minimise the impact of any subselection when performing unsupervised tasks. We demonstrate the significant improvements associated with PCov-CUR and PCov-FPS selections for applications to chemistry and materials science, typically reducing by a factor of two the number of features and samples required to achieve a given level of regression accuracy

Improving sample and feature selection with principal covariates regression

Funder: Trinity College, University of Cambridge; doi: http://dx.doi.org/10.13039/501100000727Abstract: Selecting the most relevant features and samples out of a large set of candidates is a task that occurs very often in the context of automated data analysis, where it improves the computational performance and often the transferability of a model. Here we focus on two popular subselection schemes applied to this end: CUR decomposition, derived from a low-rank approximation of the feature matrix, and farthest point sampling (FPS), which relies on the iterative identification of the most diverse samples and discriminating features. We modify these unsupervised approaches, incorporating a supervised component following the same spirit as the principal covariates (PCov) regression method. We show how this results in selections that perform better in supervised tasks, demonstrating with models of increasing complexity, from ridge regression to kernel ridge regression and finally feed-forward neural networks. We also present adjustments to minimise the impact of any subselection when performing unsupervised tasks. We demonstrate the significant improvements associated with PCov-CUR and PCov-FPS selections for applications to chemistry and materials science, typically reducing by a factor of two the number of features and samples required to achieve a given level of regression accuracy