Predictive Modeling of 30-Day Emergency Hospital Transport of German Patients Using a Personal Emergency Response: Retrospective Study and Comparison with the United States

Abstract

Background Predictive analytics based on data from remote monitoring of elderly via a personal emergency response system (PERS) in the United States can identify subscribers at high risk for emergency hospital transport. These risk predictions can subsequently be used to proactively target interventions and prevent avoidable, costly health care use. It is, however, unknown if PERS-based risk prediction with targeted interventions could also be applied in the German health care setting. Objective The objectives were to develop and validate a predictive model of 30-day emergency hospital transport based on data from a German PERS provider and compare the model with our previously published predictive model developed on data from a US PERS provider. Methods Retrospective data of 5805 subscribers to a German PERS service were used to develop and validate an extreme gradient boosting predictive model of 30-day hospital transport, including predictors derived from subscriber demographics, self-reported medical conditions, and a 2-year history of case data. Models were trained on 80% (4644/5805) of the data, and performance was evaluated on an independent test set of 20% (1161/5805). Results were compared with our previously published prediction model developed on a data set of PERS users in the United States. Results German PERS subscribers were on average aged 83.6 years, with 64.0% (743/1161) females, with 65.4% (759/1161) reported 3 or more chronic conditions. A total of 1.4% (350/24,847) of subscribers had one or more emergency transports in 30 days in the test set, which was significantly lower compared with the US data set (2455/109,966, 2.2%). Performance of the predictive model of emergency hospital transport, as evaluated by area under the receiver operator characteristic curve (AUC), was 0.749 (95% CI 0.721-0.777), which was similar to the US prediction model (AUC=0.778 [95% CI 0.769-0.788]). The top 1% (12/1161) of predicted high-risk patients were 10.7 times more likely to experience an emergency hospital transport in 30 days than the overall German PERS population. This lift was comparable to a model lift of 11.9 obtained by the US predictive model. Conclusions Despite differences in emergency care use, PERS-based collected subscriber data can be used to predict use outcomes in different international settings. These predictive analytic tools can be used by health care organizations to extend population health management into the home by identifying and delivering timelier targeted interventions to high-risk patients. This could lead to overall improved patient experience, higher quality of care, and more efficient resource use.