JMIR Publications

ABSTRACT

In the United States, ~9% of people have asthma. Each year, asthma incurs high healthcare cost and many hospital encounters covering 1.8 million emergency room visits and 439,000 hospitalizations. A small percentage of patients with asthma use most healthcare resources. To improve outcomes and cut resource use, many healthcare systems use predictive models to prospectively find high-risk patients and enroll them in care management for preventive care. For maximal benefit from costly care management with limited service capacity, only patients at the highest risk should be enrolled. Yet, prior models built by others miss >50% of true highest-risk patients and mislabel many low-risk patients as high risk, leading to suboptimal care and wasted resources. To address this issue, we recently built three site-specific models to predict hospital encounters for asthma and gained up to 11%+ better performance. But, these models do not generalize well across sites and patient subgroups, creating two gaps before translating these models into clinical use. This paper points out these two gaps and outlines two corresponding solutions: a) a new machine learning technique to create cross-site generalizable predictive models to accurately find high-risk patients, and b) a new machine learning technique to automatically raise model performance for poorly performing subgroups while maintaining model performance on other subgroups. This gives a roadmap for future research.