Cutting $5 billion burden: AI tool targets unplanned hospitalisations

Digital & Innovation: In a bold move aimed at transforming healthcare and driving down costs, a leading provider of health analytics software is launching an innovative artificial intelligence (AI) tool that could reshape the landscape of general practice. The company’s latest offering, the ‘Risk of Hospitalisation’ Report, harnesses the power of data and predictive algorithms to identify patients at high risk of unplanned hospital visits within the next year.

The need for such a tool is pressing, as recent reports from the respected Grattan Institute revealed a staggering 750,000 potentially preventable hospitalisations across Australia in 2017-18 alone. This resulted in a massive financial burden on the healthcare system, estimated to be between $2.475 billion and $4.8 billion.

Pen CS aims to address this issue head-on by empowering healthcare providers with actionable insights into their practice populations. The new CAT (Clinical Audit Tool) function utilises a sophisticated Predictive Risk Algorithm that takes into account various factors, including patient demographics, socio-economic status, medical history, and lifestyle choices. By analysing this data, the algorithm accurately assesses the likelihood of an unplanned hospital visit within the next 12 months for individual patients.

Dr Kean-Seng Lim, Chief Medical Advisor at Pen CS and Practice Principal at Mt Druitt Medical Centre in Sydney, emphasised the potential of this ground-breaking technology. He explained that the algorithm would enable healthcare providers to identify existing care gaps and tailor interventions to specific patient needs.

“By utilising the innovative Pen CS CAT platform, this application enables better insights, which facilitates forward-planning and better targeted health interventions, enabling healthcare providers to define specific patient needs, and determine appropriate actions. The risk stratification model allows GPs to examine risk of hospitalisation at an individual patient level, prompting the proactive delivery of tailored care to those who need it the most,” said Dr Lim.

A comprehensive study by the Australian Institute of Health and Welfare (AIHW) revealed that out of the 750,000 potentially preventable hospitalisations, 85,000 were vaccine-preventable, 330,000 were related to acute conditions such as dental issues and cellulitis, and 345,000 were associated with chronic diseases like asthma and chronic obstructive pulmonary disease.

The potential cost savings resulting from proactive care pathways developed by GPs are staggering. Pen CS CEO Edweana Wenkart highlighted that if only 10% of potentially preventable hospitalisations could be avoided through these measures, it could divert around 75,000 patients per year from hospital admission. This would result in a remarkable total savings of up to $480 million for the healthcare system.

However, the implications of the Risk of Hospitalisation Report extend far beyond financial benefits. Ms Wenkart described an exciting paradigm shift in patient care, where GPs take a proactive role in keeping patients healthy, managing their longevity, and helping them regain control over their lives. This new model of care redefines well-being and places primary care at the forefront of healthcare delivery.

The Predictive Risk model is based on de-identified Australian primary care data and builds on the success of the algorithm previously implemented in approximately 120 health services participating in the government’s Health Care Homes Program. Over 10,000 patients were enrolled in the trial, which focused on improving care for individuals with chronic and complex health conditions. The integrated care plans and coordinated measures employed during the trial resulted in better outcomes and enhanced patient satisfaction.

The Risk of Hospitalisation CAT Report holds immense value for various disease states, particularly diabetes mellitus (DM) and heart disease (HD), which are major comorbidities in high-risk patients. Patients with diabetes represent a fifth of all unplanned hospital readmissions within 30 days, while heart failure is strongly associated with unplanned hospitalisation, comorbidity, and mortality risk.

As primary care shifts towards a more proactive and personalised model, patients can look forward to a new era of healthcare. Instead of simply treating ailments, GPs will take a holistic approach, focusing on prevention, longevity, and empowering patients to take control of their lives.

By harnessing the power of data and predictive algorithms, healthcare providers can now identify those at the highest risk of hospitalisation and intervene proactively, saving lives, improving health outcomes, and ushering in a new era of value-based healthcare.

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