Journal Publication of International Research for Engineering and Management (JOIREM)

Hospital prediction using data mining

MS. Janvi Ahire,

MS. Rupali Nikam, MS. Shruti Parkhe, MS. Vaishnavi Pathak

Prof.S.R Jadhav
HOD Prof.V.D Badgujar

Department of computer Engineering, Brahma Valley College of engineering and research

Institute Nashik

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Abstract - One of the most critical problems in healthcare is predicting the likelihood of hospital readmission
in case of chronic diseases such as diabetes to be able to allocate necessary resources such as beds, rooms,
specialists, and medical staff, for an acceptable quality of service. Unfortunately relatively few research
studies in the literature attempted to tackle this problem; the majority of the research studies are concerned
with predicting the likelihood of the diseases themselves. Numerous machine learning techniques are suitable
for prediction. Nevertheless, there is also shortage in adequate comparative studies that specify the most
suitable techniques for the prediction process. Towards this goal, this paper presents a comparative study
among five common techniques in the literature for predicting the likelihood of hospital readmission in case of
diabetic patients. Those techniques are logistic regression (LR) analysis, multi-layer perceptron (MLP), Naïve
Bayesian (NB) classifier, decision tree, and support vector machine (SVM). The comparative study is based on
realistic data gathered from a number of hospitals in the United States. The comparative study revealed that
SVM showed best performance, while the NB classifier and LR analysis were the worst.
Key Words: Decision tree; hospital readmission; logistic regression; machine learning; multi-layer
perceptron; Naïve Bayesian classifier; support vector machines

1.INTRODUCTION
Nowadays, numerous chronic diseases, such as diabetes, are widespread in the world; and the number of
patients is increasing continuously. The estimated number of diabetic adults in 2014 was 422 million versus
108 million in 1980 [1]. Such patients visit hospitals frequently, requiring continuous preparation for
ensuring the availability of required resources including hospital beds, rooms, and enough medical staff for
an acceptable quality of service. Accordingly, predicting the likelihood of readmission of a given patient is
of ultimate importance. In fact readmission during a one month period (30 days) of discharge indicates "a
high-priority healthcare quality measure" and the goal is to address this problem [2].
Machine learning, which is one of the most important branches of artificial intelligence, provides methods
and techniques for learning from experience [3]. Researchers often use it for complex statistical analysis
tasks [4]. It is a wide multidisciplinary domain which is based on numerous
disciplines including, but not limited to, data processing, statistics, algebra, knowledge analytics,
information theory, control theory, biology, statistics, cognitive science, philosophy, and complexity of
computations. This field plays an important role in term of discovering valuable knowledge from databases
which could contain records of supply maintenance, medical records, financial transactions, applications
of loans, etc. [5].
As indicated in Fig. 1, machine learning techniques can be broadly classified into three main categories
[3]. Supervised learning techniques involve learning from training data, guided by the data scientist. There
are two basic types of learning missions: classification and regression. Models of classification attempt to
predict distinguished classes, such as blood groups, while models of regression prognosticate numerical
values [3]. In unsupervised learning, on the other hand, the system could attempt to find hidden data
patterns, associations among features or variables, or data trends [3], [4]. The main objective of

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unsupervised learning is the ability to specify hidden structures or data distributions without being subject
to supervision or the prior categorization of the training data [6]. Finally, in reinforcement learning the
system attempts to learn through interactions (trial and error) with a dynamic environment. During this
learning mode, the computer program provides access to a dynamic environment in order to perform a
specific objective. It is worth noting that in this case, the system does not have prior
knowledge regarding the environment‟s behavior, and the only way to figure it out is through trial and
error [3], [7], [8].
According to Kaelbling et al., the term healthcare informatics refers to the combination between
machine learning and healthcare with the purpose of specifying interest patterns [9]. In addition to this, it
has the potential for establishing a good relationship between patients and doctors, and minimizing the
increasing cost of healthcare [10]. The goal of this paper is to apply machine learning techniques, and
specifically prediction techniques, for predicting the likelihood of readmission of patients to hospitals. This
problem hasn‟t been adequately addressed in the literature. In fact most research efforts are oriented towards
prediction of diseases. Machine learning includes numerous analytic techniques for prediction and the literature lacks adequate
comparative studies
that assist in selecting a suitable technique for this purpose. Our research is based on a large data set
collected by numerous United States hospitals [11], [12]. In short, this paper has two main contributions as
follows:
Analyzing five most common machine learning techniques for prediction and providing a comparative
study among them.
Addressing the problem of patient readmission to hospitals, since it has been rarely addressed by
researchers.
Organization of the rest of the paper is as follows: First, we present background about the machine
learning techniques considered in this research. This is followed by related work to highlight the contributions
of the paper. We then present our methodology and discuss the results of the experiments. Finally, we

sum up this work via a conclusion and discussion of possible future work.

This section discusses the five basic machine learning techniques employed in this research study.
A. Logistic Regression Analysis
Regression is a statistical notion that can be used to identify the relationship weight between one variable
called the dependent variable and a group of other changeable variables denoted as the independent
variables. Logistic regression (LR) is a non-linear regression model, used to estimate the likelihood that an
event will occur as a function of others [13].

B. Artificial Neural Network

An Artificial Neural Network (ANN) is a computational model which attempts to emulate the human
brain parallel processing nature. An ANN is a network of strongly interconnected processing elements
(neurons), which operate in parallel [14] inspired by the biological nervous systems [15]. ANNs are broadly
used in many researches because they are capable of modeling non-linear systems, where relationships
among variables are either unknown of quite complicated [14]. An example of an ANN is the Multi-Layer

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Perceptron (MLP), which is typically formed of three layers of neurons (input layer, output layer, and hidden
layer) and its neurons use non- linear functions for data processing [16].
C. Naïve Bayesian Classifier
Naïve Bayesian (NB) classifier relies on applying Bayes‟ theorem to estimate the most probable
membership of a given event in one of a set of possible classes. It is described as being naïve, since it
assumes independence among variables used in the classification process [15], [17], [18].
D. Support Vector Machine
Support vector machines (SVMs) are supervised learning models, which can be applied for
classification analysis and regression analysis. They have been proposed by Vapnik in 1995. They can
perform both linear and non-linear classification tasks [5], [12], [17], [19]. Decision trees are one of the
most famous techniques in machine learning. A decision tree relies on classification by using attribute
values for making decisions. In general, a decision tree is a group of nodes, leaves, a root and branches
[20]. Many algorithms have been proposed in the literature for implementing decision trees. One important
algorithm is CART (Classification and Regression Tree). It is used for dealing with continuous and
categorical variables [8], [21].
RELATED WORK:
Many researchers attempted to use machine learning techniques in healthcare problems other than
hospital readmission likelihood prediction. For example, Arun and Sittidech used K-Nearest Neighbor
(KNN), NB, and decision trees with boosting, bagging, and ensemble learning in diabetes classification.
Their experiments confirmed that the highest accuracy is obtained by applying bagging with decision trees
[22]. On the other hand, Perveen et al. attempted to improve the performance of such algorithms using
AdaBoost. The evaluation of experimental outcomes showed that AdaBoost had better performance in
comparison to bagging [23]. Orabi et al. [24] suggested integrating regression with randomization for
predicting diabetes cases according to age, with an accuracy of 84%. Other researchers proposed building
a predictive model using three machine learning techniques, which are random forests (RFs), LR, and
SVMs; for predicting diabetes in Indians females, in addition to the factors causing diabetes. Their
comparative study concluded that RFs had the best performance among the others [25].
Relatively few research studies addressed the problem of hospital readmission likelihood prediction.
For example, Strack et al. used statistical models for this purpose [12]. Other researchers focused on
comparing different machine learning techniques for addressing this problem. For example, Kerexeta
[26] proposed two approaches. In the first, they combined supervised and unsupervised classification
techniques, while in the latter, they combined NB and decision trees. They showed that the former approach
had a better performance in comparison to the latter in terms of readmission predictioTo sum up, relatively
few research efforts in healthcare are concerned with the problem of prediction of hospital readmission
likelihood. Additionally, there is a shortage of adequate comparative studies for comparing machine
learning techniques used for prediction. Hence, this paper attempts to tackle those two problems by
comparing five common machine learning techniques for tackling the problem of hospital readmission

likelihood prediction based on real data.

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of

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METHODOLOGY:

Before starting the comparative study, it is important to understand the data, perform preprocessing if
necessary, and select features appropriate for the experiments as depicted in Fig. 2. Those tasks are explained
below. It is worth noting that all the experiments were conducted using Python.
A. Data Preparation
1) Understanding data: In this study, we exploited a sample of a diabetes patients‟ dataset, which has
been extracted from many hospitals in the United States [11], [12]. This dataset includes 3090 instances in
the age range of 30-50 and with 18 attributes. Table I depicts the variables of the dataset together with their
descriptions. The scientific meanings of those variables are beyond the scope of this paper. Fig. 3 through 8
depict the distribution of those features.
2) Data pre-processing: This is a very important stage which includes data transformation and cleaning.
In data transformation, some variables were transformed from categorical to binary (0/1) such as (Change,
DM, G, and A). Some other variables were transformed from integer to string such as AS, DI, and AS. In
data cleaning, some values of categorical data were missing and had to be accounted for. For this purpose,
we employed imputation (substitution) via the mode of the categorical data.
B. Feature Selection: In this step, we perform feature selection for dimensionality reduction. In other
words, we select the most relevant features. In this study, towards this goal, we assessed the impact of
variables on our target. This helped us eliminate variables with low importance. Features which have

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high influence on accuracy are the most important [27]. We used the Gradient Boosting technique [28]
for categorical features. Table II demonstrates the average
Variable
Variables
Data type
Abbreviation

Race R Categorical
Gender G Categorical
Age A Categorical

Admission type Id AT Integer

Discharge disposition Id DI Integer
Admission source Id AS Integer
Medical specialty MS Categorical
A1Cresult A1Cresult Categorical
Time in hospital TH Integer
Number of lab procedures NL Integer
Number of procedures NP Integer
Number of medications NM Integer
Number of outpatient NO Integer
Number of emergency NE Integer
Number of inpatient NI Integer
Number of diagnosis ND Integer
Change Change Categorical
DiabetesMed DM Categorical
DM 0.008867 Rejected

Naïve bayesian classifier: A NB model was created using Gaussian Naive Bayes, which assumes that the
attributes follow a natural distribution.

1) Multi-Layer perceptron: We built a MLP network using 18 inputs. The number of neurons in a
hidden layer was
5. The function of the neurons was stochastic gradient descent. The maximum number of iterations was
300, and the two outputs were (readmitted < 30 and readmitted > 30). Table V illustrates that result of MLP
weight matrix after training.

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RESULTS AND DISCUSSION:

This work utilized various performance measures to compare the studied techniques [31]. Specifically,
we relied on accuracy, recall, precision, and F1 scores for this purpose. Those parameters are defined in terms
of the true positives (TP), true negatives (TN), false positives (FP), and false negatives (FN) as indicated in
equations (1) through (4). TPs are cases in which we predicted yes (they will be readmitted in a month
period), and they were really readmitted. TNs are cases in which we predicted no, and they were not
readmitted. On the other hand, FPs are cases in which we predicted yes, but they were not actually
readmitted; Type I error. Finally, FNs are cases in which we predicted no, but they were actuallyreadmitted;
Type II error.

CONCLUSIONS:
This paper presented a comparative study among five machine learning techniques; namely LR, MLP,
NB classifier, decision trees, and SVMS; for predicting the likelihood of hospital readmission of diabetes
patients. The study relied on real data collected from hospitals in the United States. Based on the study, the
SVM provided the best performance. Nevertheless, the study will be extended to compare additional
techniques and larger datasets will be considered as well.

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