A Two-Stage Model to Predict Surgical Patients' Lengths of Stay From an Electronic Patient Database

Abstract

Soaring healthcare costs and the growing demand for services require us to use healthcare resources more efficiently. Randomness in resource requirements makes the care delivery process less efficient. Our aim is to reduce the uncertainty in patients' resource requirements, and we achieve that objective by classifying patients into similar resource user groups. In this article, we develop a two-stage classification model to classify patients into lower variability resource user groups by using electronic patient records. There are various statistical tools for classifying patients into lower variability resource user groups. However, classification and regression tree (CART) analysis is a more suitable method for analyzing healthcare data because it has some distinct features. For example, it can handle the interaction between predictor variables naturally, it is nonparametric in nature, and it is relatively insensitive to the curse of dimensionality. We found that the CART analysis is also useful for determining the patient attributes that can explain the variability in resource requirements. Furthermore, we observed that some of the covariates, such as the principal prescribed procedure code, the admission point, and the operating surgeon, were able to explain up to 53.43% of the variability in patients' lengths of stay (LoS). Reducing the uncertainty in patients' LoS predictions helps us manage patient flow efficiently and subsequently obtain a better throughput.