Explainable Admission-Level Predictive Modeling for Prolonged Hospital Stay in Elderly Populations: Challenges in Low- and Middle-Income Countries

Prolonged length of stay (pLoS) is a significant factor associated with the risk of adverse in-hospital events. We develop and explain a predictive model for pLos using admission-level patient and hospital administrative data. The approach includes a feature selection method by selecting non-correlated features with the highest information value. The method uses features weights of evidence to select a representative within cliques from graph theory. The prognosis study analyzed the records from 120,354 hospital admissions at the Hospital Alma Mater de Antioquia between January 2017 and March 2022. After a cleaning process the dataset was split into training (67%), test (22%), and validation (11%) cohorts. A logistic regression model was trained to predict the pLoS in two classes: less than or greater than 7 days. The performance of the model was evaluated using accuracy, precision, sensitivity, specificity, and AUC-ROC metrics. The feature selection method returns nine interpretable variables, enhancing the models' transparency. In the validation cohort, the pLoS model achieved a specificity of 0.83 (95% CI, 0.82-0.84), sensitivity of 0.64 (95% CI, 0.62-0.65), accuracy of 0.76 (95% CI, 0.76-0.77), precision of 0.67 (95% CI, 0.66-0.69), and AUC-ROC of 0.82 (95% CI, 0.81-0.83). The model exhibits strong predictive performance and offers insights into the factors that influence prolonged hospital stays. This makes it a valuable tool for hospital management and for developing future intervention studies aimed at reducing pLoS.

Selecting Interpretability Techniques for Healthcare Machine Learning models

In healthcare there is a pursuit for employing interpretable algorithms to assist healthcare professionals in several decision scenarios. Following the Predictive, Descriptive and Relevant (PDR) framework, the definition of interpretable machine learning as a machine-learning model that explicitly and in a simple frame determines relationships either contained in data or learned by the model that are relevant for its functioning and the categorization of models by post-hoc, acquiring interpretability after training, or model-based, being intrinsically embedded in the algorithm design. We overview a selection of eight algorithms, both post-hoc and model-based, that can be used for such purposes.