AIMC Topic: Risk Adjustment

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Improved American College of Surgeons NSQIP Hospital Benchmarking with Risk Adjustment for Many CPT Codes Rather Than Just the Principal Code.

Journal of the American College of Surgeons Sep 16, 2025
BACKGROUND: Because of technical limitations inherent to logistic regression, NSQIP benchmarking has historically risk adjusted for procedure using only 1 principal CPT code among other predictors. This has the potential to create bias (favorable or ...
Humans Female Male Hospitals Quality Improvement Surgical Procedures, Operative Risk Adjustment Current Procedural Terminology Logistic Models United States Benchmarking
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Risk adjusted EWMA control chart based on support vector machine with application to cardiac surgery data.

Scientific reports Apr 26, 2024
In the current study, we demonstrate the use of a quality framework to review the process for improving the quality and safety of the patient in the health care department. The researchers paid attention to assessing the performance of the health car...
Support Vector Machine Cardiac Surgical Procedures Humans Risk Adjustment Risk Factors
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Risk adjustment for regional healthcare funding allocations with ensemble methods: an empirical study and interpretation.

The European journal of health economics : HEPAC : health economics in prevention and care Jan 3, 2024
We experiment with recent ensemble machine learning methods in estimating healthcare costs, utilizing Finnish data containing rich individual-level information on healthcare costs, socioeconomic status and diagnostic data from multiple registries. Ou...
Linear Models Risk Adjustment Health Care Costs Finland Empirical Research Female Humans Male Machine Learning Socioeconomic Factors
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Assessment of Machine Learning to Estimate the Individual Treatment Effect of Corticosteroids in Septic Shock.

JAMA network open Dec 1, 2020
IMPORTANCE: The survival benefit of corticosteroids in septic shock remains uncertain.
Clinical Decision-Making Female Aged Male Machine Learning Prognosis Intensive Care Units Hydrocortisone Critical Care Risk Adjustment Organ Dysfunction Scores Glucocorticoids Shock, Septic Randomized Controlled Trials as Topic Humans Fludrocortisone
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Incorporating machine learning and social determinants of health indicators into prospective risk adjustment for health plan payments.

BMC public health May 1, 2020
BACKGROUND: Risk adjustment models are employed to prevent adverse selection, anticipate budgetary reserve needs, and offer care management services to high-risk individuals. We aimed to address two unknowns about risk adjustment: whether machine lea...
Middle Aged Health Promotion Insurance, Health Risk Adjustment Cost-Benefit Analysis Social Determinants of Health Female Adult Male Humans Machine Learning Prospective Studies
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Comparison of statistical and machine learning models for healthcare cost data: a simulation study motivated by Oncology Care Model (OCM) data.

BMC health services research Apr 25, 2020
BACKGROUND: The Oncology Care Model (OCM) was developed as a payment model to encourage participating practices to provide better-quality care for cancer patients at a lower cost. The risk-adjustment model used in OCM is a Gamma generalized linear mo...
Machine Learning Computer Simulation Risk Adjustment Models, Statistical Health Care Costs Humans Medical Oncology Linear Models
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Comparison of Machine Learning Methods With National Cardiovascular Data Registry Models for Prediction of Risk of Bleeding After Percutaneous Coronary Intervention.

JAMA network open Jul 3, 2019
IMPORTANCE: Better prediction of major bleeding after percutaneous coronary intervention (PCI) may improve clinical decisions aimed to reduce bleeding risk. Machine learning techniques, bolstered by better selection of variables, hold promise for enh...
Female Aged Male Models, Statistical Postoperative Hemorrhage Risk Assessment United States Risk Adjustment Registries Humans Comparative Effectiveness Research Percutaneous Coronary Intervention Clinical Decision Rules Machine Learning Coronary Artery Disease
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Exploring the use of machine learning for risk adjustment: A comparison of standard and penalized linear regression models in predicting health care costs in older adults.

PloS one Mar 6, 2019
BACKGROUND: Payers and providers still primarily use ordinary least squares (OLS) to estimate expected economic and clinical outcomes for risk adjustment purposes. Penalized linear regression represents a practical and incremental step forward that p...
Health Care Costs Female Comorbidity Humans Aged Linear Models Adult Machine Learning Risk Adjustment Retrospective Studies Male
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Robust Machine Learning Variable Importance Analyses of Medical Conditions for Health Care Spending.

Health services research Mar 11, 2018
OBJECTIVE: To propose nonparametric double robust machine learning in variable importance analyses of medical conditions for health spending.
Health Expenditures Databases, Factual Risk Adjustment Female Male Demography Humans United States Machine Learning Chronic Disease
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A Machine Learning Framework for Plan Payment Risk Adjustment.

Health services research Feb 19, 2016
OBJECTIVE: To introduce cross-validation and a nonparametric machine learning framework for plan payment risk adjustment and then assess whether they have the potential to improve risk adjustment.
Risk Assessment Humans Databases, Factual Models, Statistical Adult Machine Learning Risk Adjustment Middle Aged Algorithms
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