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Predicting falls-related admissions in older adults in Alberta, Canada: a machine-learning falls prevention tool developed using population administrative health data

OBJECTIVE: To construct a machine-learning (ML) model for health systems with organised falls prevention programmes to identify older adults at risk for fall-related admissions. DESIGN: This prognostic study used population-level administrative health data to develop an ML prediction model. SETTING:...

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Autores principales: Sharma, Vishal, Kulkarni, Vinaykumar, Joon, Tanya, Eurich, Dean T, Simpson, Scot H, Voaklander, Don, Wright, Bruce, Samanani, Salim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10445355/
https://www.ncbi.nlm.nih.gov/pubmed/37607796
http://dx.doi.org/10.1136/bmjopen-2022-071321
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author Sharma, Vishal
Kulkarni, Vinaykumar
Joon, Tanya
Eurich, Dean T
Simpson, Scot H
Voaklander, Don
Wright, Bruce
Samanani, Salim
author_facet Sharma, Vishal
Kulkarni, Vinaykumar
Joon, Tanya
Eurich, Dean T
Simpson, Scot H
Voaklander, Don
Wright, Bruce
Samanani, Salim
author_sort Sharma, Vishal
collection PubMed
description OBJECTIVE: To construct a machine-learning (ML) model for health systems with organised falls prevention programmes to identify older adults at risk for fall-related admissions. DESIGN: This prognostic study used population-level administrative health data to develop an ML prediction model. SETTING: This study took place in Alberta, Canada during 2018–2019. PARTICIPANTS: Albertans aged 65 and older with at least one prior admission. Those with palliative conditions or emigrated out of Alberta were excluded. EXPOSURE: Unit of analysis was the individual person. MAIN OUTCOMES/MEASURES: We identified fall-related admissions. A CatBoost model was developed on 2018 data to predict risk of fall-related emergency department visits or hospitalisations. Temporal validation was done using 2019 data to evaluate model performance. We reported discrimination, calibration and other relevant metrics measured at the end of 2019 on both ranked predictions and predicted probability thresholds. A cost-savings simulation was performed using 2019 data. RESULTS: Final number of study participants was 224 445. The validation set had 203 584 participants with 19 389 fall-related events (9.5% pretest probability) and an ML model c-statistic of 0.70. The highest ranked predictions had post-test probabilities ranging from 40% to 50%. Net benefit analysis presented mixed results with some net benefit using the ML model in the 6%–30% range. The top 50 percentile of predicted risks represented nearly $C60 million in health system costs related to falls. Intervening on the top 25 or 50 percentiles of predicted risk could realise substantial (up to $C16 million) savings. CONCLUSION: ML prediction models based on population-level administrative data can assist health systems with fall prevention programmes identify older adults at risk of fall-related admissions and reduce costs. ML predictions based on ranked predictions or probability thresholds could guide subsequent interventions to mitigate fall risks. Increased access to diverse forms of data could improve ML performance and further reduce costs.
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spelling pubmed-104453552023-08-24 Predicting falls-related admissions in older adults in Alberta, Canada: a machine-learning falls prevention tool developed using population administrative health data Sharma, Vishal Kulkarni, Vinaykumar Joon, Tanya Eurich, Dean T Simpson, Scot H Voaklander, Don Wright, Bruce Samanani, Salim BMJ Open Epidemiology OBJECTIVE: To construct a machine-learning (ML) model for health systems with organised falls prevention programmes to identify older adults at risk for fall-related admissions. DESIGN: This prognostic study used population-level administrative health data to develop an ML prediction model. SETTING: This study took place in Alberta, Canada during 2018–2019. PARTICIPANTS: Albertans aged 65 and older with at least one prior admission. Those with palliative conditions or emigrated out of Alberta were excluded. EXPOSURE: Unit of analysis was the individual person. MAIN OUTCOMES/MEASURES: We identified fall-related admissions. A CatBoost model was developed on 2018 data to predict risk of fall-related emergency department visits or hospitalisations. Temporal validation was done using 2019 data to evaluate model performance. We reported discrimination, calibration and other relevant metrics measured at the end of 2019 on both ranked predictions and predicted probability thresholds. A cost-savings simulation was performed using 2019 data. RESULTS: Final number of study participants was 224 445. The validation set had 203 584 participants with 19 389 fall-related events (9.5% pretest probability) and an ML model c-statistic of 0.70. The highest ranked predictions had post-test probabilities ranging from 40% to 50%. Net benefit analysis presented mixed results with some net benefit using the ML model in the 6%–30% range. The top 50 percentile of predicted risks represented nearly $C60 million in health system costs related to falls. Intervening on the top 25 or 50 percentiles of predicted risk could realise substantial (up to $C16 million) savings. CONCLUSION: ML prediction models based on population-level administrative data can assist health systems with fall prevention programmes identify older adults at risk of fall-related admissions and reduce costs. ML predictions based on ranked predictions or probability thresholds could guide subsequent interventions to mitigate fall risks. Increased access to diverse forms of data could improve ML performance and further reduce costs. BMJ Publishing Group 2023-08-22 /pmc/articles/PMC10445355/ /pubmed/37607796 http://dx.doi.org/10.1136/bmjopen-2022-071321 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Epidemiology
Sharma, Vishal
Kulkarni, Vinaykumar
Joon, Tanya
Eurich, Dean T
Simpson, Scot H
Voaklander, Don
Wright, Bruce
Samanani, Salim
Predicting falls-related admissions in older adults in Alberta, Canada: a machine-learning falls prevention tool developed using population administrative health data
title Predicting falls-related admissions in older adults in Alberta, Canada: a machine-learning falls prevention tool developed using population administrative health data
title_full Predicting falls-related admissions in older adults in Alberta, Canada: a machine-learning falls prevention tool developed using population administrative health data
title_fullStr Predicting falls-related admissions in older adults in Alberta, Canada: a machine-learning falls prevention tool developed using population administrative health data
title_full_unstemmed Predicting falls-related admissions in older adults in Alberta, Canada: a machine-learning falls prevention tool developed using population administrative health data
title_short Predicting falls-related admissions in older adults in Alberta, Canada: a machine-learning falls prevention tool developed using population administrative health data
title_sort predicting falls-related admissions in older adults in alberta, canada: a machine-learning falls prevention tool developed using population administrative health data
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10445355/
https://www.ncbi.nlm.nih.gov/pubmed/37607796
http://dx.doi.org/10.1136/bmjopen-2022-071321
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