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.
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.
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 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 |
The predictive model identified several key factors that significantly influence readmission risk:
| Factor | Impact |
|---|---|
| Total Prior Visits | +4.36 |
| Number of Medications | +0.28 |
| Lab Procedures | +0.10 |
| Number of Diagnoses | +0.01 |
| Factor | Impact |
|---|---|
| Outpatient Visits | -3.12 |
| Prior Inpatient Visits | -1.96 |
| Emergency Visits | -1.54 |
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.
| 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% |
Analysis of hospital readmission rates and CMS penalties across all 50 states reveals significant regional variation:
| 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 |
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.
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.
Cost: $300-500 per patient | Effectiveness: 25-35% readmission reduction
In-home nursing assessments for highest-risk patients with mobility or transportation barriers.
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 |
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.