A Hierarchical Bayesian Model for Predicting the Rate of Nonacceptable In-Patient Hospital Utilization
预测不必要住院索赔比例的分层贝叶斯模型
A nonacceptable claim (NAC) is an insurance claim for an unnecessary hospital stay. This study establishes a statistical model that predicts the NAC rate. The model supplements current insurer programs that rely on detailed audits of patient medical records. Hospital discharge claim records are used as inputs in the statistical model to predict retrospectively the probability that a hospital admission is nonacceptable. A full Bayesian hierarchical logistic regression model…