Risk factors for unplanned readmission in ischemic stroke patients within 31 days: a random forest algorithm research_Chinese Journal of Evidence-Based Medicine

Authors：

WEN Tiancai ^1,2,3 ^# , LIU Baoyan ² ^# ,  ZHANG Yanning ¹

1. School of Computer Science, Northwestern Polytechnical University, Xi'an, 710129, P.R.China;
2. Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, P.R.China;
3. Data Center of Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, P.R.China;

Corresponding?author：

ZHANG Yanning, Email: ynzhang@nwpu.edu.cn

Keywords：

Ischemic stroke; Unplanned readmission; Random forest; Hospitalization; Risk factor

DOI：

10.7507/1672-2531.201809094

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Objectives To investigate risk factors for unplanned readmission in ischemic stroke patients within 31 days by using random forest algorithm.Methods The record of readmission patients with ischemic stroke within 31 days from 24 hospitals in Beijing between between 2015 and 2016 were collected. Patients were divided into two groups according to the occurrence of readmission within 31 days or not. Chi-squared or Mann-Whitney U test was used to select variables into the random forest algorithm. The precision coefficient and the Gini coefficient were used to comprehensively assess the importance of all variables, and select the more important variables and use the margind effect to assess relative risk of different levels.Results A total of 3 473 patients were included, among them 960 (27.64%) were readmitted within 31 days after stroke hospitalization. Based on the result of random forest, the most important variables affecting the risk of unplanned readmission within 31 days included the length of hospital stay, age, medical expense payment, rank of hospital, and occupation. When hospitalization was within 1 month, 10-day-hospitalization-stay patients had the lowest risk of rehospitalization; the younger the patients was, the higher the risk of readmission was. For ranks of hospital, patients from tertiary hospital had higher risk than secondary hospital. Furthermore, patients whose medical expenses were paid by free medical service and whose occupations were managers or staffs had higher risk of readmission within 31 days.Conclusions The unplanned readmission risk within 31 days of discharged ischemic stroke patients was connected not only with disease, but also with personal social and economic factors. Thus, more attention should be paid to both the medical process and the personal and family factors of stroke patients.

Citation： WEN Tiancai, LIU Baoyan, ZHANG Yanning. Risk factors for unplanned readmission in ischemic stroke patients within 31 days: a random forest algorithm research. Chinese Journal of Evidence-Based Medicine, 2019, 19(5): 532-538. doi: 10.7507/1672-2531.201809094 Copy

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21.	Smajlovi? D. Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag, 2015, 11: 157-164.
22.	Renna R, Pilato F, Profice P, et al. Risk factor and etiology analysis of ischemic stroke in young adult patients. J Stroke Cerebrovasc Dis, 2014, 23(3): e221-e227.
23.	Lewington S, Lacey B, Clarke R, et al. The burden of hypertension and associated risk for cardiovascular mortality in China. JAMA Intern Med, 2016, 176(4): 524-532.
24.	Qin Y, Wang R, Ma X, et al. Prevalence, awareness, treatment and control of diabetes mellitus-A population based study in Shanghai, China. Int J Environ Res Public Health, 2016, 13(5): E512.
25.	楊功煥. 2010年全球成人煙草調查-中國報告. 北京: 中國三峽出版社, 2011.
26.	聶靜, 向陽. 對某三甲綜合醫院住院天數與住院費用的分析. 新疆醫學, 2015, 45(9): 1354-1356.
27.	方黎明. 新型農村合作醫療和農村醫療救助制度對農村貧困居民就醫經濟負擔的影響. 中國農村觀察, 2013, (2): 80-92.
28.	于長永. 疾病類型、醫療保險與農民就醫機構選擇行為研究. 農業技術經濟, 2017, (2): 82-92.

1. 世界衛生組織. 前十位死亡原因. Available at: http://www.who.int/zh/news-room/fact-sheets/detail/the-top-10-causes-of-death.
2. 陳偉偉, 高潤霖, 劉力生, 等. 《中國心血管病報告2017》概要. 中國循環雜志, 2018, 33(1): 1-8.
3. 國家衛生和計劃生育委員會. 2016中國衛生和計劃生育統計年鑒. 北京: 中國協和醫科大學出版社, 2016.
4. Ma Y, Xiong X, Li J, et al. Effect of health insurance on direct hospitalisation costs for in-patients with ischaemic stroke in China. Aust Health Rev, 2018, 42(1): 39-44.
5. 劉娟, 楊棟, 李系仁, 等. 某院31天內再入院現狀與影響因素分析. 中國衛生質量管理, 2011, 18(6): 22-25.
6. Kind AJ, Smith MA, Liou JI, et al. The price of bouncing back: one-year mortality and payments for acute stroke patients with 30-day bounce-backs. J Am Geriatr Soc, 2008, 56(6): 999-1005.
7. Kilkenny MF, Longworth M, Pollack M, et al. Factors associated with 28-day hospital readmission after stroke in Australia. Stroke, 2013, 44(8): 2260-2268.
8. Thomas JW, Holloway JJ. Investigating early readmission as an indicator for quality of care studies. Med Care, 1991, 29(4): 377-394.
9. 劉玉琦, 郝曉剛, 王洪麗, 等. 某院出院患者31天內再住院分析與討論. 中國衛生質量管理, 2014, 21(4): 40-41.
10. Bhattacharya P, Khanal D, Madhavan R, et al. Why do ischemic stroke and transient ischemic attack patients get readmitted? J Neurol Sci, 2011, 307(1-2): 50-54.
11. 唐愛豐, 祝東林, 謝薇, 等. 腦卒中再入院的原因及其危險因素分析. 中華腦血管病雜志(電子版), 2013, 7(1): 376-381.
12. Rao A, Barrow E, Vuik S, et al. Systematic review of hospital readmissions in stroke patients. Stroke Res Treat, 2016, 2016(1): 1-11.
13. Tseng MC, Lin HJ. Readmission after hospitalization for stroke in Taiwan: results from a national sample. J Neurol Sci, 2009, 284(1-2): 52-55.
14. Lewsey J, Ebueku O, Jhund PS, et al. Temporal trends and risk factors for readmission for infections, gastrointestinal and immobility complications after an incident hospitalisation for stroke in Scotland between 1997 and 2005. BMC Neurol, 2015, 15: 3.
15. 李欣海. 隨機森林模型在分類與回歸分析中的應用. 應用昆蟲學報, 2013, 50(4): 1190-1197.
16. 衛生部醫政司. 神經內科臨床路徑. 北京: 人民衛生出版社, 2012.
17. 中華醫學會. 缺血性中風臨床路徑. Available at: http://www.cma.org.cn/attachment/2016612/1465718140116.docx.
18. 王亞靜. 用歸一法分析某院2011年床位工作效率. 中國衛生統計, 2013, 30(6): 915-916.
19. 施霽桉, 趙麗. 對病床周轉率的反思. 中外醫學研究, 2015, 13(22): 148-149, 150.
20. Singhal AB, Biller J, Elkind MS, et al. Recognition and management of stroke in young adults and adolescents. Neurology, 2013, 81(12): 1089-1097.
21. Smajlovi? D. Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag, 2015, 11: 157-164.
22. Renna R, Pilato F, Profice P, et al. Risk factor and etiology analysis of ischemic stroke in young adult patients. J Stroke Cerebrovasc Dis, 2014, 23(3): e221-e227.
23. Lewington S, Lacey B, Clarke R, et al. The burden of hypertension and associated risk for cardiovascular mortality in China. JAMA Intern Med, 2016, 176(4): 524-532.
24. Qin Y, Wang R, Ma X, et al. Prevalence, awareness, treatment and control of diabetes mellitus-A population based study in Shanghai, China. Int J Environ Res Public Health, 2016, 13(5): E512.
25. 楊功煥. 2010年全球成人煙草調查-中國報告. 北京: 中國三峽出版社, 2011.
26. 聶靜, 向陽. 對某三甲綜合醫院住院天數與住院費用的分析. 新疆醫學, 2015, 45(9): 1354-1356.
27. 方黎明. 新型農村合作醫療和農村醫療救助制度對農村貧困居民就醫經濟負擔的影響. 中國農村觀察, 2013, (2): 80-92.
28. 于長永. 疾病類型、醫療保險與農民就醫機構選擇行為研究. 農業技術經濟, 2017, (2): 82-92.

Chinese Journal of Evidence-Based Medicine

Risk factors for unplanned readmission in ischemic stroke patients within 31 days: a random forest algorithm research

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