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oai:recercat.cat:2445/1727292025-11-19T19:07:20Zcom_2072_1057col_2072_478858col_2072_478902col_2072_478917col_2072_478921

Health outcomes from home hospitalization: multisource predictive modeling Calvo, Mireia González, Ruben Seijas, Nuria Vela, Emili Hernández, Carme Batiste, Guillem Miralles Barrachina, Felip Roca Torrent, Josep Cano Franco, Isaac Jané, Raimon Atenció domiciliària Salut pública Home care services Public health Background: Home hospitalization is widely accepted as a cost-effective alternative to conventional hospitalization for selected patients. A recent analysis of the home hospitalization and early discharge (HH/ED) program at Hospital Clínic de Barcelona over a 10-year period demonstrated high levels of acceptance by patients and professionals, as well as health value-based generation at the provider and health-system levels. However, health risk assessment was identified as an unmet need with the potential to enhance clinical decision making. Objective: The objective of this study is to generate and assess predictive models of mortality and in-hospital admission at entry and at HH/ED discharge. Methods: Predictive modeling of mortality and in-hospital admission was done in 2 different scenarios: at entry into the HH/ED program and at discharge, from January 2009 to December 2015. Multisource predictive variables, including standard clinical data, patients' functional features, and population health risk assessment, were considered. Results: We studied 1925 HH/ED patients by applying a random forest classifier, as it showed the best performance. Average results of the area under the receiver operating characteristic curve (AUROC; sensitivity/specificity) for the prediction of mortality were 0.88 (0.81/0.76) and 0.89 (0.81/0.81) at entry and at home hospitalization discharge, respectively; the AUROC (sensitivity/specificity) values for in-hospital admission were 0.71 (0.67/0.64) and 0.70 (0.71/0.61) at entry and at home hospitalization discharge, respectively. Conclusions: The results showed potential for feeding clinical decision support systems aimed at supporting health professionals for inclusion of candidates into the HH/ED program, and have the capacity to guide transitions toward community-based care at HH discharge. 2020-12-14T14:06:29Z 2020-12-14T14:06:29Z 2020-10-07 2020-12-14T14:06:29Z info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Reproducció del document publicat a: https://doi.org/10.2196/21367 Journal of Medical Internet Research, 2020, vol. 22, num. 10, p. e21367 https://doi.org/10.2196/21367 cc-by (c) Calvo, Mireia et al., 2020 http://creativecommons.org/licenses/by/3.0/es info:eu-repo/semantics/openAccess JMIR Publications Articles publicats en revistes (Medicina)