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

Efficient Discovery of Heterogeneous Treatment Effects in Randomized Experiments via Anomalous Pattern Detection

In the recent literature on estimating heterogeneous treatment effects, each proposed method makes its own set of restrictive assumptions about the intervention's effects and which subpopulations to explicitly estimate. Moreover, the majority of the literature provides no mechanism to identify which subpopulations are the most affected--beyond manual inspection--and provides little guarantee on the correctness of the identified subpopulations. Therefore, we propose Treatment Effect Subset Scan (TESS), a new method for discovering which subpopulation in a randomized experiment is most significantly affected by a treatment. We frame this challenge as a pattern detection problem where we efficiently maximize a nonparametric scan statistic over subpopulations. Furthermore, we identify the subpopulation which experiences the largest distributional change as a result of the intervention, while making minimal assumptions about the intervention's effects or the underlying data generating process. In addition to the algorithm, we demonstrate that the asymptotic Type I and II error can be controlled, and provide sufficient conditions for detection consistency--i.e., exact identification of the affected subpopulation. Finally, we validate the efficacy of the method by discovering heterogeneous treatment effects in simulations and in real-world data from a well-known program evaluation study