Implementation of Artificial Intelligence-Based Clinical Decision Support to Reduce Hospital Readmissions at a Regional Hospital.

Background: Hospital readmissions are a key quality metric, which has been tied to reimbursement. One strategy to reduce readmissions is to direct resources to patients at the highest risk of readmission. This strategy necessitates a robust predictive model coupled with effective, patient-centered interventions.
Objective: The aim of this study was to reduce unplanned hospital readmissions through the use of artificial intelligence-based clinical decision support.
Methods: A commercially vended artificial intelligence tool was implemented at a regional hospital in La Crosse, Wisconsin between November 2018 and April 2019. The tool assessed all patients admitted to general care units for risk of readmission and generated recommendations for interventions intended to decrease readmission risk. Similar hospitals were used as controls. Change in readmission rate was assessed by comparing the 6-month intervention period to the same months of the previous calendar year in exposure and control hospitals.
Results: Among 2,460 hospitalizations assessed using the tool, 611 were designated by the tool as high risk. Sensitivity and specificity for risk assignment were 65% and 89%, respectively. Over 6 months following implementation, readmission rates decreased from 11.4% during the comparison period to 8.1% ( p  < 0.001). After accounting for the 0.5% decrease in readmission rates (from 9.3 to 8.8%) at control hospitals, the relative reduction in readmission rate was 25% ( p  < 0.001). Among patients designated as high risk, the number needed to treat to avoid one readmission was 11.
Conclusion: We observed a decrease in hospital readmission after implementing artificial intelligence-based clinical decision support. Our experience suggests that use of artificial intelligence to identify patients at the highest risk for readmission can reduce quality gaps when coupled with patient-centered interventions.
Competing Interests: Mayo Clinic and the third-party AI-based CDS software tool developer (Jvion; Johns Creek, Georgia) have existing licensing agreements for unrelated technology. Jvion was not involved in the production of this manuscript except to answer queries made during the peer review process regarding details of the software. Jvion otherwise played no role in the conception, drafting, or revision of the manuscript nor did they play a role in the decision to submit it for publication. The pilot project was funded with internal Mayo Clinic funds.
(Georg Thieme Verlag KG Stuttgart · New York.)