ReadmitRisk Executive Report

Hospital Readmission Risk Analysis and Cost Exposure Assessment - UCI Diabetes Dataset

Data Source Notice: This analysis uses the UCI Diabetes 130-US Hospitals dataset (1999-2008) for demonstration purposes. Risk patterns identified may differ from current clinical practice. Cost exposure figures are calculated using 2024 industry benchmarks ($15,000 average readmission cost). This report is intended for portfolio/demonstration purposes and should not be used for clinical decision-making.

71,518
Total Patients Analyzed
7,083
High-Risk Patients (60%+)
$78.5M
Total Cost Exposure
8.8%
Readmission Rate

Executive Summary

This report presents findings from our machine learning-based risk stratification analysis of 71,518 patients from 130 US hospitals. The analysis identifies patients at elevated risk for 30-day hospital readmissions and quantifies the associated cost exposure.

Key Finding

1,931 patients (2.7%) have critical risk scores above 80% and require immediate intervention. These patients represent $25.1M in potential cost exposure and should be prioritized for care management outreach.

Risk Stratification Overview

1,931
Critical (80%+)
2,232
Very High (70-80%)
2,920
High (60-70%)
64,435
Moderate/Low (<60%)

Cost Exposure by Risk Tier

Risk Tier Patient Count Avg Risk Score Total Cost Exposure Avg Exposure/Patient
Critical (80%+) 1,931 86.6% $25,096,147 $12,996
Very High (70-80%) 2,232 74.7% $25,025,322 $11,212
High (60-70%) 2,920 64.8% $28,379,923 $9,719
Total High-Risk 7,083 73.9% $78,501,392 $11,083

Risk Factor Analysis

The predictive model identified several key factors that significantly influence readmission risk:

Risk-Increasing Factors

Factor Impact
Total Prior Visits +4.36
Number of Medications +0.28
Lab Procedures +0.10
Number of Diagnoses +0.01

Protective Factors

Factor Impact
Outpatient Visits -3.12
Prior Inpatient Visits -1.96
Emergency Visits -1.54

Clinical Interpretation

Patients with high total healthcare utilization (visits, medications, diagnoses) face elevated readmission risk, indicating complex care needs. However, outpatient follow-up care appears strongly protective, suggesting that continuity of care and regular monitoring can mitigate readmission risk.

Population Distribution

Risk Score Range Patient Count Percentage Visual
0-20% 37,663 52.7%
20-40% 17,548 24.5%
40-60% 9,224 12.9%
60-80% 5,152 7.2%
80-100% 1,931 2.7%

Geographic Analysis

Analysis of hospital readmission rates and CMS penalties across all 50 states reveals significant regional variation:

Top 10 States by Readmission Rate

Rank State Avg Readmission Rate Hospitals Est. Total Penalties
1 Louisiana 17.8% 109 $9,333,648
2 West Virginia 17.6% 55 $3,411,907
3 Mississippi 17.1% 83 $5,312,423
4 Oklahoma 16.8% 112 $4,469,212
5 Kentucky 16.1% 96 $9,231,976
6 Alabama 16.0% 98 $9,437,750
7 Maryland 16.0% 47 $2,726,538
8 Missouri 16.0% 113 $4,391,642
9 Tennessee 16.0% 116 $3,452,958
10 New York 15.9% 183 $9,471,439

National Summary

51
States Analyzed
4,692
Total Hospitals
14.6%
National Avg Rate
$153M
Est. Total Penalties

Recommended Interventions

1. Transitional Care Management (TCM)

Cost: $200-400 per patient | Effectiveness: 20-30% readmission reduction

Structured post-discharge follow-up with medication reconciliation and care coordination. Best for patients with complex conditions.

2. Post-Discharge Phone Calls

Cost: $50-100 per patient | Effectiveness: 10-15% readmission reduction

Nurse-led calls within 48-72 hours of discharge to assess symptoms, medication adherence, and follow-up appointment scheduling.

3. Home Health Visits

Cost: $300-500 per patient | Effectiveness: 25-35% readmission reduction

In-home nursing assessments for highest-risk patients with mobility or transportation barriers.

ROI Analysis

Potential return on investment for targeting the critical risk tier (1,931 patients):

Scenario Intervention Cost Readmissions Prevented Savings Net ROI
Conservative (15% reduction) $386,200 290 $4,350,000 $3,963,800
Moderate (25% reduction) $579,300 483 $7,245,000 $6,665,700
Aggressive (35% reduction) $772,400 676 $10,140,000 $9,367,600

Key Takeaway

Even conservative intervention programs targeting the highest-risk patients can achieve 10:1 or greater ROI while improving patient outcomes and reducing CMS penalty exposure.

Next Steps

  1. Prioritize Critical Tier: Deploy care management resources to the 1,931 patients with 80%+ risk scores immediately.
  2. Implement TCM Program: Establish transitional care management protocols for high-risk discharges.
  3. Enhance Outpatient Follow-up: Given the protective effect of outpatient visits, ensure follow-up appointments are scheduled before discharge.
  4. Regional Focus: Concentrate quality improvement efforts in states with highest readmission rates (Louisiana, West Virginia, Mississippi).
  5. Monitor and Iterate: Track intervention outcomes and refine the predictive model quarterly.