Ability of clinical data to predict readmission in Child and Adolescent Mental Health Services

Abstract

This study addresses the challenge of predicting readmissions in Child and Adolescent Mental Health Services (CAMHS) by analyzing the predictability of readmissions over short, medium, and long term periods. Using health records spanning 35 years, which included 22,643 patients and 30,938 episodes of care, we focused on the episode of care as a central unit, defined as a referral-discharge cycle that incorporates assessments and interventions. Data pre-processing involved handling missing values, normalizing, and transforming data, while resolving issues related to overlapping episodes and correcting registration errors where possible. Readmission prediction was inferred from electronic health records (EHR), as this variable was not directly recorded. A binary classifier distinguished between readmitted and non-readmitted patients, followed by a multi-class classifier to categorize readmissions based on timeframes: short (within 6 months), medium (6 months - 2 years), and long (more than 2 years). Several predictive models were evaluated based on metrics like AUC, F1-score, precision, and recall, and the K-prototype algorithm was employed to explore similarities between episodes through clustering. The optimal binary classifier (Oversampled Gradient Boosting) achieved an AUC of 0.7005, while the multi-class classifier (Oversampled Random Forest) reached an AUC of 0.6368. The K-prototype resulted in three clusters as optimal (SI: 0.256, CI: 4473.64). Despite identifying relationships between care intensity, case complexity, and readmission risk, generalizing these findings proved difficult, partly because clinicians often avoid discharging patients likely to be readmitted. Overall, while this dataset offers insights into patient care and service patterns, predicting readmissions remains challenging, suggesting a need for improved analytical models that consider patient development, disease progression, and intervention effects.