2.

0 LITERATURE REVIEW

2.1 Diabetes Mellitus and Its Readmission Risk Factors

Diabetes mellitus is a serious chronic illness that leads to readmissions as a result of

insufficient management of the disease. Although the percentage of readmissions that can be
avoided is uncertain, some of them are probably avoidable. A number of factors, particularly
those that relate to clinician or system-level issues, that raise the risk of readmission may be
addressed. Diabetes patients who had been hospitalized had a 30% risk of twice or more
hospitalisations, which accounted for more than 50% of all hospitalisations and
hospitalisation costs (Wang et al., 2022). Many factors, including a flawed initial diagnosis, a
relapse, a premature discharge, and others, can result in an unintentional readmission.

The Centers for Medicare and Medicaid Services now uses the 30-day readmission
rate following an index hospitalisation as a major hospital performance measure, and it is
coming under more scrutiny as an indicator of poor patient care. Accidental readmission
results in repeated medical resource waste, as well as raising the financial burden on the
patient. Clinical and demographic factors may raise the likelihood of readmission, according
to several studies. Depending on how long the time interval passes between discharge and
readmission, risk factors might change.

In a cohort research conducted at a single facility, it was discovered that risk variables
for readmissions that occurred quickly (within a week of release) differed somewhat from
those for readmissions that occurred later (between 8 and 30 days after discharge). Those
with DM had a higher risk of being readmitted with additional coexisting diseases, such as
heart failure, myocardial infarction, and cardiac surgery, than patients without DM did. The
development and application of methods to lower readmission rates in this high-risk
population will be made possible by better understanding of the factors linked to early
readmission in patients with diabetes.

Readmission rates were 40.5, 25.8, and 22.5%, respectively, for patients with a
primary, secondary, or no known diagnosis of DM (Ostling et al., 2017). The need to better
understand the causes of readmission in patients with a main diagnosis of diabetes is
highlighted by the extremely high readmission rate among patients who had an index
admission for diabetes. In order to customise therapy to hospital glucose control and beyond
into education and close post-discharge follow-up with the objective of preventing early
readmission, it is important to recognise and comprehend a few of these factors.
 2.2 Application of Machine Learning

Applications of machine learning (ML) are frequently linked to data engineering as

the primary concern of the research. Predictive feature sets that are correctly classified lead to
reliable data models, which in turn guarantee accurate learning strategies. When developing a
model, it is possible to include irrelevant and incorrect attributes, which could lead to faulty
prediction execution. In addition to taking specific learning schemes into account, feature
selection required a combination of search and attribute value assessment. While models like
boosted decision trees, random forests, and neural nets are accurate, they are frequently
difficult to read and understand. However, simple methods like single decision trees, Naive-
Bayes, and logistic regression frequently have much lower accuracy.

According to Shang et al., (2021), a decision tree (DT) is used to construct the
fundamental classification technique known as the random forest (RF). A weak classifier is
assumed to be each DT, while a strong classifier is produced by the collection of responses.
Each DT is comparatively independent, and the category of input data is determined by
mastering a set of binary problems. This method is advanced in that it is simple to
understand, accurate, and robust. Furthermore, the Naive Bayes (NB) classifier is also one of
the most often used ML models. When the target value is provided, the probabilities of each
category are computed for the given data to be classified, and the given data corresponds to
the category with the highest probabilities, it is considered that the attributes are independent
of one another.

The article also highlighted how the Random Forest (RF) algorithm performs well in
terms of prediction, and that it is better suited for forecasting unintentional readmissions. RF,
one of the most used algorithms in classification work today, performs better in terms of
prediction and can provide a range of important measurements. Also, the Random Forest
method is also better at detecting unintentional readmission due to its higher AUC value. In
the majority of datasets, the RF approach can perform better than the DT algorithm,
indicating that it might be used to compute feature importance.

In addition, the majority of the readmission literature has mostly used logistic
regression models to calculate patients' chances of being readmitted. According to their
research paper, logistic regression is a reliable technique and classifier for predicting
readmission within 30 days, with an accuracy rate that exceeds 80%. Additionally, five
different classification models were employed to analyse the readmission risk for patients
who frequently visit the emergency department (ED) and logistic regression is
understandable and makes it simple to assess the strength of each variable.

Additionally, the decision tree was marginally superior to the other models,
outperforming the prediction skill of the Neural Network, and the logistic regression model
exhibits high predictive capabilities for 30-day readmission rates (Ben-Assuli & Padman,
2018). While readmission reduction is a widely studied problem, little is known regarding
which models work better, particularly for frequently hospitalised patients as well as models
that go beyond logistic regression.