1. Identification of Patient Profiles with High Risk of Hospital Re-Admissions for Acute COPD Exacerbations (AECOPD) in France Using a Machine Learning Model
- Author
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Geoffrey Berthon, Katell Le Lay, Pierre Louis Lleu, Boris Melloni, Arnaud Cavailles, L. Luciani, Thomas Flament, Florent Dayde, Marie Laurent, D. Caumette, Stéphane Motola, Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Pathologie respiratoire et allergologie [CHU Limoges], CHU Limoges, Ecologie fonctionnelle et biogéochimie des sols et des agro-écosystèmes (UMR Eco&Sols), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Institut de Recherche pour le Développement (IRD)-Institut National de la Recherche Agronomique (INRA)-Centre international d'études supérieures en sciences agronomiques (Montpellier SupAgro)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), AP-HP, hôpital Henri-Mondor, Department of Internal Medicine and Geriatrics, F-94010 Creteil, France, IMRB - CEPIA/'Clinical Epidemiology And Ageing : Geriatrics, Primary Care and Public Health' [Créteil] (U955 Inserm - UPEC), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de Pneumologie [CHRU Tours], and Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)
- Subjects
Male ,medicine.medical_specialty ,Exacerbation ,Population ,Psychological intervention ,decision tree analysis ,International Journal of Chronic Obstructive Pulmonary Disease ,Machine learning ,computer.software_genre ,Patient Readmission ,Machine Learning ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,0302 clinical medicine ,Epidemiology ,cost ,Humans ,Medicine ,030212 general & internal medicine ,Acute copd exacerbations ,education ,Aged ,Retrospective Studies ,Original Research ,education.field_of_study ,COPD ,business.industry ,Retrospective cohort study ,rehospitalisation ,General Medicine ,medicine.disease ,Comorbidity ,Hospitals ,Hospitalization ,comorbidity ,030228 respiratory system ,Disease Progression ,Female ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,France ,Artificial intelligence ,business ,computer - Abstract
Arnaud Cavailles,1 Boris Melloni,2 Stéphane Motola,3 Florent Dayde,3 Marie Laurent,3 Katell Le Lay,4 Didier Caumette,5 Laura Luciani,4 Pierre Louis Lleu,6 Geoffrey Berthon,7 Thomas Flament8 1Service de Pneumologie, Institut du Thorax, CHU de Nantes, Nantes, France; 2Service de Pneumologie, CHU Dupuytren, Limoges, France; 3HEVA, Lyon, France; 4HEOR/RWE, Boehringer Ingelheim, Paris, France; 5Institutional and Hospital Partnership, Boehringer Ingelheim, Paris, France; 6Medical Affairs, Boehringer Ingelheim, Paris, France; 7CHRU Tours, Tours, France; 8Service de Pneumologie, CHRU Bretonneau, Tours, FranceCorrespondence: Marie Laurent 186 Avenue Thiers, Lyon 69006, FranceTel +33 4 72 74 25 60Email mlaurent@hevaweb.comPurpose: To characterise patients with chronic obstructive pulmonary disease (COPD) who are rehospitalised for an acute exacerbation, to estimate the cost of these hospitalisations, to characterise high risk patient sub groups and to identify factors potentially associated with the risk of rehospitalisation.Patients and Methods: This was a retrospective study using the French NationalHospital Discharge Database. All patients aged ≥ 40 years hospitalised for an acute exacerbation of COPD between 2015 and 2016 were identified and followed for six months. Patients with at least one rehospitalisation for acute exacerbation of COPD constituted the rehospitalisation analysis population. A machine learning model was built to study the factors associated with the risk of rehospitalisation using decisiontree analysis. A direct cost analysis was performed from the perspective of national health insurance.Results: A totalof 143,006 eligible patients were hospitalised for an acute exacerbation of COPD (AECOPD) in 2015– 2016 (mean age: 74 years; 62.1% men). 25,090 (18.8%) were rehospitalised for another exacerbation within six months. In this study, 8.5% of patients died during or immediately following the index hospitalisation and 10.5% died during or immediately after rehospitalisation (p < 0.001). The specific cost of these rehospitalisations was € 5304. The overall total cost per patient of all AECOPD-related stays was € 9623, being significantly higher in patients who were rehospitalised (€ 16,275) compared to those who were not (€ 8208). In decisiontree analysis, the most important driver of rehospitalisation was hospitalisation in the previous two years (contributing 85% of the information).Conclusion: Rehospitalisations for acute exacerbations of COPD carry a high epidemiological and economic burden. Since hospitalisation for an acute exacerbation is the most important determinant of future rehospitalisations, management of COPD needs to focus on interventions aimed at decreasing the rehospitalisation risk of in order to lower the burden of disease.Keywords: comorbidity, rehospitalisation, decisiontree analysis, cost
- Published
- 2020