Study on medical dispute prediction model and its clinical-application effectiveness based on machine learning

Abstract

BACKGROUND: Medical dispute is a global public health issue, which has been garnering increasing attention. In this study, we used machine learning (ML) method to establish a dispute prediction model and explored the clinical-application efficiency of this model in effectively reducing the occurrence of medical disputes. METHODS: Retrospective study of All disputes filed by Gansu Medical Mediation Committee from 2019 to 2021 and patients with the same hospital level as that of the dispute group and hospitalization year were randomly selected as the control group in 1:1 ratio. SPSS software was used for univariate feature selection of the 14 factors that may cause disputes, and factors with statistical differences were selected. The data were divided into training and test sets in a 7:3 ratio. Six ML models were selected, and Python was used to establish a dispute prediction model. The area under the curve (AUC) of the receiver operating characteristic curve (ROC), sensitivity, specificity, accuracy, precision, average precision (AP), and F1 score were used to characterize the fitting and accuracy of the models, while decision curve analysis (DCA) was used to evaluate their clinical utility. RESULTS: A total of 1189 patients in the dispute and control groups were extracted. Following 11 influencing factors were selected: the inpatient department, doctor title, patient age, patient gender, patient occupation, payment method, hospitalization days, hospitalization times, discharge method, blood transfusion volume, and hospitalization espenses. Compared to other models, the AUC (0.945, 95% CI 0.913-0.981), Sensitivity (0.887), Accuracy (0.887), AP (0.834), and F1 score (0.880) of the random forest model were higher than those of other models, while the DCA curve indicated its high clinical benefits. CONCLUSIONS: Inpatient department, hospitalization expenses, and discharge type are the primary influencing factors of dispute. Random forest exhibited high dispute prediction and clinical-application value and is expected to be promoted for offline dispute prediction.

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