Network analytics and machine learning for predicting length of stay in elderly patients with chronic diseases at point of admission

Exploring the integration of medical and preventive chronic disease health management in the context of big data

Chronic non-communicable diseases (NCDs) pose a significant global health burden, exacerbated by aging populations and fragmented healthcare systems. This study employs a comprehensive literature review method to systematically evaluate the integration of medical and preventive services for chronic disease management in the context of big data, focusing on pre-hospital risk prediction, in-hospital clinical prevention, and post-hospital follow-up optimization. Through synthesizing existing research, we propose a novel framework that includes the development of machine learning models and interoperable health information platforms for real-time data sharing. The analysis reveals significant regional disparities in implementation efficacy, with developed eastern regions demonstrating advanced closed-loop management via unified platforms, while western rural areas struggle with manual workflows and data fragmentation. The integration of explainable AI (XAI) and blockchain-secured care pathways enhances clinical decision-making while ensuring GDPR-compliant data governance. The study advocates for phased implementation strategies prioritizing data standardization, federated learning architectures, and community-based health literacy programs to bridge existing disparities. Results show a 30-35% reduction in redundant diagnostics and a 15-20% risk mitigation for cardiometabolic disorders through precision interventions, providing a scalable roadmap for resilient public health systems aligned with the "Healthy China" initiative.

Development of Multiservice Machine Learning Models to Predict Postsurgical Length of Stay and Discharge Disposition at the Time of Case Posting

Objective

Develop machine learning (ML) models to predict postsurgical length of stay (LOS) and discharge disposition (DD) for multiple services with only the data available at the time of case posting.

Background

Surgeries are scheduled largely based on operating room resource availability with little attention to downstream resource availability such as inpatient bed availability and the care needs after hospitalization. Predicting postsurgical LOS and DD at the time of case posting could support resource allocation and earlier discharge planning.

Methods

This retrospective study included 63,574 adult patients undergoing elective inpatient surgery at a large academic health system. We used surgical case data available at the time of case posting and created gradient-boosting decision tree classification models to predict LOS as short (≤1 day), medium (2-4 days), and prolonged stays (≥5 days) and DD as home versus nonhome.

Results

The LOS model achieved an area under the receiver operating characteristic curve (AUC) of 0.81. Adding relative value unit and historical LOS through the similarity cascade increased the accuracy of short and prolonged LOS prediction by 9.0% and 3.9% to 72.9% and 74%, respectively, compared with a model without these features (P = 0.001). The DD model had an AUC of 0.88 for home versus nonhome prediction.

Conclusions

We developed ML models to predict, at the time of case posting, the postsurgical LOS and DD for adult elective inpatient cases across multiple services. These models could support case scheduling, resource allocation, optimal bed utilization, earlier discharge planning, and preventing case cancelation due to bed unavailability.

Leveraging Artificial Intelligence to Predict and Manage Complications in Patients With Multimorbidity: A Literature Review

Artificial intelligence (AI) is revolutionizing healthcare by improving diagnostic accuracy, streamlining treatment protocols, and augmenting patient care, especially in the management of multimorbidity. This review assesses the applications of AI in forecasting and controlling problems in multimorbid patients, emphasizing predictive analytics, real-time data integration, and enhancements in diagnostics. Utilizing extensive datasets from electronic health records and medical imaging, AI models facilitate early complication prediction and prompt therapies in diseases such as cancer, cardiovascular disorders, and diabetes. Notable developments encompass AI systems for the diagnosis of lung and breast cancer, markedly decreasing false positives and minimizing superfluous follow-ups. A comprehensive literature search was performed via PubMed and Google Scholar, applying Boolean logic with keywords such as "artificial intelligence", "multimorbidity", "predictive analytics", "machine learning", and "diagnosis". Articles published in English from January 2010 to December 2024, encompassing original research, systematic reviews, and meta-analyses regarding the use of AI in managing multimorbidity and healthcare decision-making, were included. Studies not pertinent to therapeutic applications, devoid of outcome measurements, or restricted to editorials were discarded. This review emphasizes AI's capacity to augment diagnostic precision and boost clinical results while also identifying substantial hurdles, including data bias, ethical issues, and the necessity for rigorous validation and longitudinal research to guarantee sustainable integration in clinical environments. This review's limitations encompass the possible exclusion of pertinent studies due to language and publication year constraints, as well as the disregard for grey literature, potentially constraining the comprehensiveness of the findings.

Comorbidity progression analysis: patient stratification and comorbidity prediction using temporal comorbidity network

Objective

The study aims to identify distinct population-specific comorbidity progression patterns, timely detect potential comorbidities, and gain better understanding of the progression of comorbid conditions among patients.

Methods

This work presents a comorbidity progression analysis framework that utilizes temporal comorbidity networks (TCN) for patient stratification and comorbidity prediction. We propose a TCN construction approach that utilizes longitudinal, temporal diagnosis data of patients to construct their TCN. Subsequently, we employ the TCN for patient stratification by conducting preliminary analysis, and typical prescription analysis to uncover potential comorbidity progression patterns in different patient groups. Finally, we propose an innovative comorbidity prediction method by utilizing the distance-matched temporal comorbidity network (TCN-DM). This method identifies similar patients with disease prevalence and disease transition patterns and combines their diagnosis information with that of the current patient to predict potential comorbidity at the patient's next visit.

Results

This study validated the capability of the framework using a real-world dataset MIMIC-III, with heart failure (HF) as interested disease to investigate comorbidity progression in HF patients. With TCN, this study can identify four significant distinctive HF subgroups, revealing the progression of comorbidities in patients. Furthermore, compared to other methods, TCN-DM demonstrated better predictive performance with F1-Score values ranging from 0.454 to 0.612, showcasing its superiority.

Conclusions

This study can identify comorbidity patterns for individuals and population, and offer promising prediction for future comorbidity developments in patients.

Machine learning applications in preventive healthcare: A systematic literature review on predictive analytics of disease comorbidity from multiple perspectives

Artificial intelligence is constantly revolutionizing biomedical research and healthcare management. Disease comorbidity is a major threat to the quality of life for susceptible groups, especially middle-aged and elderly patients. The presence of multiple chronic diseases makes precision diagnosis challenging to realize and imposes a heavy burden on the healthcare system and economy. Given an enormous amount of accumulated health data, machine learning techniques show their capability in handling this puzzle. The present study conducts a review to uncover current research efforts in applying these methods to understanding comorbidity mechanisms and making clinical predictions considering these complex patterns. A descriptive metadata analysis of 791 unique publications aims to capture the overall research progression between January 2012 and June 2023. To delve into comorbidity-focused research, 61 of these scientific papers are systematically assessed. Four predictive analytics of tasks are detected: disease comorbidity data extraction, clustering, network, and risk prediction. It is observed that some machine learning-driven applications address inherent data deficiencies in healthcare datasets and provide a model interpretation that identifies significant risk factors of comorbidity development. Based on insights, both technical and practical, gained from relevant literature, this study intends to guide future interests in comorbidity research and draw conclusions about chronic disease prevention and diagnosis with managerial implications.

Applying precision medicine principles to the management of multimorbidity: the utility of comorbidity networks, graph machine learning, and knowledge graphs

The current management of patients with multimorbidity is suboptimal, with either a single-disease approach to care or treatment guideline adaptations that result in poor adherence due to their complexity. Although this has resulted in calls for more holistic and personalized approaches to prescribing, progress toward these goals has remained slow. With the rapid advancement of machine learning (ML) methods, promising approaches now also exist to accelerate the advance of precision medicine in multimorbidity. These include analyzing disease comorbidity networks, using knowledge graphs that integrate knowledge from different medical domains, and applying network analysis and graph ML. Multimorbidity disease networks have been used to improve disease diagnosis, treatment recommendations, and patient prognosis. Knowledge graphs that combine different medical entities connected by multiple relationship types integrate data from different sources, allowing for complex interactions and creating a continuous flow of information. Network analysis and graph ML can then extract the topology and structure of networks and reveal hidden properties, including disease phenotypes, network hubs, and pathways; predict drugs for repurposing; and determine safe and more holistic treatments. In this article, we describe the basic concepts of creating bipartite and unipartite disease and patient networks and review the use of knowledge graphs, graph algorithms, graph embedding methods, and graph ML within the context of multimorbidity. Specifically, we provide an overview of the application of graph theory for studying multimorbidity, the methods employed to extract knowledge from graphs, and examples of the application of disease networks for determining the structure and pathways of multimorbidity, identifying disease phenotypes, predicting health outcomes, and selecting safe and effective treatments. In today's modern data-hungry, ML-focused world, such network-based techniques are likely to be at the forefront of developing robust clinical decision support tools for safer and more holistic approaches to treating older patients with multimorbidity.

A comprehensive review of machine learning algorithms and their application in geriatric medicine: present and future

The increasing access to health data worldwide is driving a resurgence in machine learning research, including data-hungry deep learning algorithms. More computationally efficient algorithms now offer unique opportunities to enhance diagnosis, risk stratification, and individualised approaches to patient management. Such opportunities are particularly relevant for the management of older patients, a group that is characterised by complex multimorbidity patterns and significant interindividual variability in homeostatic capacity, organ function, and response to treatment. Clinical tools that utilise machine learning algorithms to determine the optimal choice of treatment are slowly gaining the necessary approval from governing bodies and being implemented into healthcare, with significant implications for virtually all medical disciplines during the next phase of digital medicine. Beyond obtaining regulatory approval, a crucial element in implementing these tools is the trust and support of the people that use them. In this context, an increased understanding by clinicians of artificial intelligence and machine learning algorithms provides an appreciation of the possible benefits, risks, and uncertainties, and improves the chances for successful adoption. This review provides a broad taxonomy of machine learning algorithms, followed by a more detailed description of each algorithm class, their purpose and capabilities, and examples of their applications, particularly in geriatric medicine. Additional focus is given on the clinical implications and challenges involved in relying on devices with reduced interpretability and the progress made in counteracting the latter via the development of explainable machine learning.

Process mining and data mining applications in the domain of chronic diseases: A systematic review

The widespread use of information technology in healthcare leads to extensive data collection, which can be utilised to enhance patient care and manage chronic illnesses. Our objective is to summarise previous studies that have used data mining or process mining methods in the context of chronic diseases in order to identify research trends and future opportunities. The review covers articles that pertain to the application of data mining or process mining methods on chronic diseases that were published between 2000 and 2022. Articles were sourced from PubMed, Web of Science, EMBASE, and Google Scholar based on predetermined inclusion and exclusion criteria. A total of 71 articles met the inclusion criteria and were included in the review. Based on the literature review results, we detected a growing trend in the application of data mining methods in diabetes research. Additionally, a distinct increase in the use of process mining methods to model clinical pathways in cancer research was observed. Frequently, this takes the form of a collaborative integration of process mining, data mining, and traditional statistical methods. In light of this collaborative approach, the meticulous selection of statistical methods based on their underlying assumptions is essential when integrating these traditional methods with process mining and data mining methods. Another notable challenge is the lack of standardised guidelines for reporting process mining studies in the medical field. Furthermore, there is a pressing need to enhance the clinical interpretation of data mining and process mining results.

Application of machine learning approaches in predicting clinical outcomes in older adults - a systematic review and meta-analysis

BACKGROUND

Machine learning-based prediction models have the potential to have a considerable positive impact on geriatric care.

DESIGN

Systematic review and meta-analyses.

PARTICIPANTS

Older adults (≥ 65 years) in any setting.

INTERVENTION

Machine learning models for predicting clinical outcomes in older adults were evaluated. A random-effects meta-analysis was conducted in two grouped cohorts, where the predictive models were compared based on their performance in predicting mortality i) under and including 6 months ii) over 6 months.

OUTCOME MEASURES

Studies were grouped into two groups by the clinical outcome, and the models were compared based on the area under the receiver operating characteristic curve metric.

RESULTS

Thirty-seven studies that satisfied the systematic review criteria were appraised, and eight studies predicting a mortality outcome were included in the meta-analyses. We could only pool studies by mortality as there were inconsistent definitions and sparse data to pool studies for other clinical outcomes. The area under the receiver operating characteristic curve from the meta-analysis yielded a summary estimate of 0.80 (95% CI: 0.76 - 0.84) for mortality within 6 months and 0.81 (95% CI: 0.76 - 0.86) for mortality over 6 months, signifying good discriminatory power.

CONCLUSION

The meta-analysis indicates that machine learning models display good discriminatory power in predicting mortality. However, more large-scale validation studies are necessary. As electronic healthcare databases grow larger and more comprehensive, the available computational power increases and machine learning models become more sophisticated; there should be an effort to integrate these models into a larger research setting to predict various clinical outcomes.

Risk prediction of heart failure in patients with ischemic heart disease using network analytics and stacking ensemble learning

BACKGROUND

Heart failure (HF) is a major complication following ischemic heart disease (IHD) and it adversely affects the outcome. Early prediction of HF risk in patients with IHD is beneficial for timely intervention and for reducing disease burden.

METHODS

Two cohorts, cases for patients first diagnosed with IHD and then with HF (N = 11,862) and control IHD patients without HF (N = 25,652), were established from the hospital discharge records in Sichuan, China during 2015-2019. Directed personal disease network (PDN) was constructed for each patient, and then these PDNs were merged to generate the baseline disease network (BDN) for the two cohorts, respectively, which identifies the health trajectories of patients and the complex progression patterns. The differences between the BDNs of the two cohort was represented as disease-specific network (DSN). Three novel network features were exacted from PDN and DSN to represent the similarity of disease patterns and specificity trends from IHD to HF. A stacking-based ensemble model DXLR was proposed to predict HF risk in IHD patients using the novel network features and basic demographic features (i.e., age and sex). The Shapley Addictive exPlanations method was applied to analyze the feature importance of the DXLR model.

RESULTS

Compared with the six traditional machine learning models, our DXLR model exhibited the highest AUC (0.934 ± 0.004), accuracy (0.857 ± 0.007), precision (0.723 ± 0.014), recall (0.892 ± 0.012) and F₁ score (0.798 ± 0.010). The feature importance showed that the novel network features ranked as the top three features, playing a notable role in predicting HF risk of IHD patient. The feature comparison experiment also indicated that our novel network features were superior to those proposed by the state-of-the-art study in improving the performance of the prediction model, with an increase in AUC by 19.9%, in accuracy by 18.7%, in precision by 30.7%, in recall by 37.4%, and in F₁ score by 33.7%.

CONCLUSIONS

Our proposed approach that combines network analytics and ensemble learning effectively predicts HF risk in patients with IHD. This highlights the potential value of network-based machine learning in disease risk prediction field using administrative data.