A study of factors related to patients’ length of stay using data mining techniques in a general hospital in southern Iran

Purpose The length of stay (LOS) in hospitals is a widely used indicator for goals such as health care management, quality control, utilizing hospital services and resources, and determining the degree of efficiency. Various methods have been used to identify the factors influencing the LOS. This study adopts a comparative approach of data mining techniques for investigating effective factors and predict the length of stay in Shahid-Mohammadi Hospital, Bandar Abbas, Iran. Methods Using a dataset consists of 526 patient records of the Shahid-Mohammadi Hospital from March 2016 to March 2017, factors affecting the LOS were ranked using information gain and correlation indices. In addition, classification models for LOS prediction were created based on nine data mining classifiers applied with and without feature selection technique. Finally, the models were compared. Results The most important factors affecting LOS are the number of para-clinical services, counseling frequency, clinical ward, the specialty and the degree of the doctor, and the cause of hospitalization. In addition, regarding to the classifiers created based on the dataset, the best accuracy (83.91%) and sensitivity (80.36%) belongs to the Logistic Regression and Naïve Bayes respectively. In addition, the best AUC (0.896) belongs to the Random Forest and Generalized Linear classifiers. Conclusion The results showed that most of the proposed models are suitable for classification of the length of stay, although the Logistic Regression might have a slightly better performance than others in term of accuracy, and this model can be used to determine the patients’ Length of Stay. In general, continuous monitoring of the factors influencing each of the performance indicators based on proper and accurate models in hospitals is important for helping management decisions.

[1]  Jian Pei,et al.  Data Mining : Concepts and Techniques 3rd edition Ed. 3 , 2011 .

[2]  J. Codde,et al.  Factors influencing patients' length of stay. , 2001, Australian health review : a publication of the Australian Hospital Association.

[3]  Robert J. Steele,et al.  Data Mining for Generalizable Pre-admission Prediction of Elective Length of Stay , 2019, 2019 IEEE 9th Annual Computing and Communication Workshop and Conference (CCWC).

[4]  Åke Grönlund,et al.  The Development of the Recovery Assessments by Phone Points (RAPP): A Mobile Phone App for Postoperative Recovery Monitoring and Assessment , 2015, JMIR mHealth and uHealth.

[5]  L. Shams,et al.  Relationship between Performance Indicators and Hospital Evaluation Score at Hospitals affiliated to Urmia University of Medical Sciences , 2011 .

[6]  M. Cabana,et al.  Factors Associated With Prolonged Emergency Department Length of Stay for Admitted Children , 2011, Pediatric emergency care.

[7]  David Parmenter,et al.  Key Performance Indicators: Developing, Implementing,and Using Winning KPIs , 2007 .

[8]  D. Adham,et al.  Predictors for Duration of Stay in Hospitals , 2015 .

[9]  Ketabi Saeedeh,et al.  FACTORS AFFECTING PATIENTS' LENGTH OF STAY IN ALZAHRA HOSPITAL BASED ON HIERARCHICAL ANALYSIS TECHNIQUE , 2011 .

[10]  M. Zahiri,et al.  Performance evaluating in hospitals affiliated in AHWAZ University of Medical Sciences based on PABON LASSO model , 2012 .

[11]  Mark A. Hall,et al.  Correlation-based Feature Selection for Machine Learning , 2003 .

[12]  Jerrold H. May,et al.  Insights from a machine learning model for predicting the hospital Length of Stay (LOS) at the time of admission , 2017, Expert Syst. Appl..

[13]  Sadeghifar Jamil,et al.  Combining multiple indicators to assess hospital performance in Iran using the Pabon Lasso Model. , 2011, The Australasian medical journal.

[14]  A. Rezapoor,et al.  Study of Daily Bed Occupancy Costs And Performance Indexes in Selected Hospitalat of Iran University of Medical Sciences in 1381 , 2005 .

[15]  Kobra Etminani,et al.  Factors Associated with Length of Hospital Stay: A Systematic Review , 2015 .

[16]  Jeffrey Dean,et al.  Scalable and accurate deep learning with electronic health records , 2018, npj Digital Medicine.

[17]  M. Jebraeily,et al.  Performance Evaluation of Hormozgan University of Medical Sciences (HUMS) hospitals based on Pabon Lasso Model , 2019, Evidence Based Health Policy, Management and Economics.

[18]  Fillia Makedon,et al.  Evaluation of classification methods for the prediction of hospital length of stay using medicare claims data , 2014, PETRA.

[19]  Jiawei Han,et al.  Data Mining: Concepts and Techniques , 2000 .

[20]  S. Vemuri,et al.  A Delphi evaluation of the factors influencing length of stay in Australian hospitals. , 1997, The International journal of health planning and management.

[21]  Peyman Rezaei Hachesu,et al.  Use of Data Mining Techniques to Determine and Predict Length of Stay of Cardiac Patients , 2013, Healthcare informatics research.

[22]  Rajkumar Roy,et al.  A framework to create key performance indicators for knowledge management solutions , 2003, J. Knowl. Manag..

[23]  Nicolas Huck,et al.  Deep neural networks, gradient-boosted trees, random forests: Statistical arbitrage on the S&P 500 , 2017, Eur. J. Oper. Res..

[24]  Victoria J. Hodge,et al.  A Survey of Outlier Detection Methodologies , 2004, Artificial Intelligence Review.

[25]  T. Hamed,et al.  FACTORS INFLUENCING THE LENGTH OF STAY IN INFECTIOUS WARD OF RAZI HOSPITAL IN AHVAZ: IRAN , 2015 .

[26]  Vandana Pursnani Janeja,et al.  Predicting Hospital Length of Stay (PHLOS): A Multi-tiered Data Mining Approach , 2012, 2012 IEEE 12th International Conference on Data Mining Workshops.

[27]  J. Friedman Greedy function approximation: A gradient boosting machine. , 2001 .

[28]  Rouh Alamini Azadeh,et al.  Comparing Performance of Selected Teaching Hospitals in Kerman and Shiraz Universities of Medical Sciences, Iran, Using Pabon-Lasso Chart , 2012 .

[29]  Somayeh Alizadeh,et al.  Extract critical factors affecting the length of hospital stay of pneumonia patient by data mining (case study: an Iranian hospital) , 2017, Artif. Intell. Medicine.

[30]  A. Karegowda,et al.  COMPARATIVE STUDY OF ATTRIBUTE SELECTION USING GAIN RATIO AND CORRELATION BASED FEATURE SELECTION , 2010 .

[31]  Minseok Song,et al.  Analysis of length of hospital stay using electronic health records: A statistical and data mining approach , 2018, PloS one.

[32]  A. Nasiripour,et al.  THE LEADERSHIP STYLES OF DISTRICT HEALTH NETWORK MANAGERS AND PERFORMANCE INDICES IN EASTERN AZERBAIJAN, IRAN; 2008 , 2009 .

[33]  Ruxandra Stoean,et al.  Ensemble of Classifiers for Length of Stay Prediction in Colorectal Cancer , 2015, IWANN.

[34]  Arab Mohammad,et al.  Analysis of Factors Affecting Length of stay in Public Hospitals in Lorestan Province, Iran , 2010 .

[35]  M. Kargari,et al.  Determining Factors Influencing Length of Stay and Predicting Length of Stay Using Data Mining in the General Surgery Department , 2016 .

[36]  M. Al-mallah,et al.  Predictors of in-hospital length of stay among cardiac patients: A machine learning approach. , 2019, International journal of cardiology.

[37]  R. Ravangard,et al.  Patients' Length of Stay in Women Hospital and Its Associated Clinical and Non-Clinical Factors, Tehran, Iran , 2011, Iranian Red Crescent medical journal.

[38]  Yoav Freund,et al.  A decision-theoretic generalization of on-line learning and an application to boosting , 1997, EuroCOLT.

[39]  Andrew W. Moore,et al.  Logistic regression for data mining and high-dimensional classification , 2004 .

[40]  Ruxandra Stoean,et al.  Interpreting Decision Support from Multiple Classifiers for Predicting Length of Stay in Patients with Colorectal Carcinoma , 2017, Neural Processing Letters.

[41]  Karim O. Elish,et al.  Machine Learning-Based Prediction of Prolonged Length of Stay in Newborns , 2018, 2018 17th IEEE International Conference on Machine Learning and Applications (ICMLA).

[42]  Tianqi Chen,et al.  XGBoost: A Scalable Tree Boosting System , 2016, KDD.

[43]  Bhumika Gupta,et al.  Analysis of Various Decision Tree Algorithms for Classification in Data Mining , 2017 .

[44]  Paulo Cortez,et al.  Using Data Mining for Prediction of Hospital Length of Stay: An Application of the CRISP-DM Methodology , 2014, ICEIS.

[45]  Chia-Lun Lo,et al.  Predicting the prolonged length of stay of general surgery patients: a supervised learning approach , 2018, Int. Trans. Oper. Res..

[46]  Dinesh U Acharya,et al.  Comparison of Different Data Mining Techniques to Predict Hospital Length of Stay , 2011 .

[47]  Geoffrey E. Hinton,et al.  Deep Learning , 2015, Nature.