Scholarlink

<p>Hospital readmission is a key quality metric, yet post-discharge interventions often yield variable results. In the first large-scale randomized evaluation of causal machine learning in a health system, we assessed whether a novel model (the Predicted Benefit Intervention (PBI) score) could identify lower-risk patients most likely to benefit from post-discharge care coordination within Kaiser Permanente Northern California (KPNC). From May to December 2022, 9959 low-risk patients at 19 KPNC hospitals were randomized to usual care or the Transitions Program, which included medication reconciliation, primary care follow-up scheduling, and weekly calls for 30 days. While 30-day readmissions declined in the intervention group (7.7% vs. 8.2%), the difference was not statistically significant. However, the observed-to-expected readmission ratio declined into randomization and remained low thereafter; this decline was statistically significant. This study demonstrates the feasibility of implementing causal machine learning at scale to improve targeting and resource allocation in care delivery.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Expanding care coordination in an integrated health system through causal machine learning

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年9月24日

查看全文
  • Ben J. Marafino,
  • Colleen Plimier,
  • Patricia Kipnis,
  • Gabriel J. Escobar,
  • Laura C. Myers,
  • Michelle C. Donnelly,
  • John D. Greene,
  • Marc D. Flagg,
  • Jessica R. Small,
  • Vincent X. Liu

摘要

Hospital readmission is a key quality metric, yet post-discharge interventions often yield variable results. In the first large-scale randomized evaluation of causal machine learning in a health system, we assessed whether a novel model (the Predicted Benefit Intervention (PBI) score) could identify lower-risk patients most likely to benefit from post-discharge care coordination within Kaiser Permanente Northern California (KPNC). From May to December 2022, 9959 low-risk patients at 19 KPNC hospitals were randomized to usual care or the Transitions Program, which included medication reconciliation, primary care follow-up scheduling, and weekly calls for 30 days. While 30-day readmissions declined in the intervention group (7.7% vs. 8.2%), the difference was not statistically significant. However, the observed-to-expected readmission ratio declined into randomization and remained low thereafter; this decline was statistically significant. This study demonstrates the feasibility of implementing causal machine learning at scale to improve targeting and resource allocation in care delivery.