Cohort profile for development of machine learning models to predict healthcare-related adverse events (Demeter): clinical objectives, data requirements for modelling and overview of data set for 2016-2018.

PURPOSE: In-hospital health-related adverse events (HAEs) are a major concern for hospitals worldwide. In high-income countries, approximately 1 in 10 patients experience HAEs associated with their hospital stay. Estimating the risk of an HAE at the individual patient level as accurately as possible is one of the first steps towards improving patient outcomes. Risk assessment can enable healthcare providers to target resources to patients in greatest need through adaptations in processes and procedures. Electronic health data facilitates the application of machine-learning methods for risk analysis. We aim, first to reveal correlations between HAE occurrence and patients' characteristics and/or the procedures they undergo during their hospitalisation, and second, to build models that allow the early identification of patients at an elevated risk of HAE. PARTICIPANTS: 143 865 adult patients hospitalised at Grenoble Alpes University Hospital (France) between 1 January 2016 and 31 December 2018. FINDINGS TO DATE: In this set-up phase of the project, we describe the preconditions for big data analysis using machine-learning methods. We present an overview of the retrospective de-identified multisource data for a 2-year period extracted from the hospital's Clinical Data Warehouse, along with social determinants of health data from the National Institute of Statistics and Economic Studies, to be used in machine learning (artificial intelligence) training and validation. No supplementary information or evaluation on the part of medical staff will be required by the information system for risk assessment. FUTURE PLANS: We are using this data set to develop predictive models for several general HAEs including secondary intensive care admission, prolonged hospital stay, 7-day and 30-day re-hospitalisation, nosocomial bacterial infection, hospital-acquired venous thromboembolism, and in-hospital mortality.

The burden of chronic pain for patients with osteoarthritis in Germany: a retrospective cohort study of claims data.

BACKGROUND: Osteoarthritis (OA) is a common condition that is often associated with chronic pain. Pain often leads patients to seek healthcare advice and treatment. In this retrospective cohort analysis of German longitudinal healthcare claims data, we aimed to explore the healthcare resource utilisation (HRU) and related healthcare costs for patients with OA who develop chronic pain. METHODS: Patient-level data was extracted from the German Institut für Angewandte Gesundheitsforschung (InGef) database. Insured persons (≥18 years) were indexed between January 2015 and December 2017 with a recent (none in the last 2 years) diagnosis of OA. HRU and costs were compared between patients categorised as with (identified via diagnosis or opioid prescription) and without chronic pain. Unweighted HRU (outpatient physician contacts, hospitalisations, prescriptions for physical therapy or psychotherapy, and incapacity to work) and healthcare costs (medication, medical aid/remedy, psychotherapy, inpatient and outpatient and sick pay in Euros [quartile 1, quartile 3]) were calculated per patient for the year following index. Due to potential demographic and comorbidity differences between the groups, inverse probability of treatment weighting (IPTW) was used to estimate weighted costs and rate ratio (RR; 95% confidence interval) of HRU by negative binomial regression modelling. RESULTS: Of 4,932,543 individuals sampled, 238,306 patients with OA were included in the analysis: 80,055 (34%) categorised as having chronic pain (24,463 via opioid prescription) and 158,251 (66%) categorised as not having chronic pain. The chronic pain cohort was slightly older, more likely to be female, and had more comorbidities. During the year following index, unweighted and IPTW-weighted HRU risk and healthcare costs were higher in patients with chronic pain vs those without for all categories. This led to a substantially higher total annual healthcare cost ─ observed mean; €6801 (1439, 8153) vs €3682 (791, 3787); estimated RR = 1.51 (1.36, 1.66). CONCLUSIONS: German patients with chronic pain and OA have higher healthcare costs and HRU than those with OA alone. Our findings suggest the need for better prevention and treatment of OA in order to reduce the incidence of chronic pain, and the resultant increase in disease burden experienced by patients.

Cost associated with hematopoietic stem cell transplantation: a retrospective claims data analysis in Germany.

AIM: Quantify hematopoietic stem cell transplantation (HSCT) costs in German patients with acute lymphoblastic leukemia (ALL), diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). METHODS: The primary outcome was direct and indirect costs in patients with ALL/DLBCL/FL who received HSCT between 2010 and 2014. Costs were evaluated two to four quarters before to eight quarters after HSCT. RESULTS: Among 258 patients with HSCT, direct costs were €290,125/patient (pediatric ALL), €246,266/patient (adult ALL), €230,399/patient (DLBCL/FL allogeneic) and €107,457/patient (DLBCL/FL autologous). Indirect costs with HSCT were €52,939/patient (adult ALL), €20,285/patient (DLBCL/FL allogeneic) and €29,881/patient (DLBCL/FL autologous). CONCLUSION: Direct and indirect costs associated with HSCT are substantial for patients with ALL, DLBCL and FL. Novel therapies that reduce HSCT use could reduce medical costs.