Systems and Methods for Reducing Patient Readmission to Acute Care Facilities

A system for generating a report that ranks patients at-risk for readmission to an acute care facility from a post-acute care facility, the system comprising:

• one or more processors;
• and
• memory storing instructions for execution by the one or more processors, the instructions including instructions for:
• receiving, from the post-acute care facility, patient data for a plurality of patients;
• inputting the patient data for the plurality of patients into a risk machine-learning system that was previously trained using historical patient data and data reflecting any readmissions from one or more post-acute care facilities to one or more acute care facilities;
• determining, by the risk machine-learning system, a risk score for each patient of the plurality of patients based on each patient's patient data, wherein each risk score represents risk of a respective patient being readmitted to an acute care facility from the post-acute care facility;
• and
• generating, for display, the report comprising a list of at least a subset of patients from the plurality of patients, where the list is ranked from the patient with the highest risk of readmission to the patient with the lowest risk of readmission.

A non-transitory computer-readable storage medium for generating a report that ranks patients at-risk for readmission to an acute care facility from a post-acute care facility having one or more processors and memory storing instructions for execution by the one or more processors, the instructions including instructions for:

• receiving, from the post-acute care facility, patient data for a plurality of patients;
• inputting the patient data for the plurality of patients into a risk machine-learning system that was previously trained using historical patient data and data reflecting any readmissions from one or more post-acute care facilities to one or more acute care facilities;
• determining, by the risk machine-learning system, a risk score for each patient of the plurality of patients based on each patient's patient data, wherein each risk score represents risk of a respective patient being readmitted to an acute care facility from the post-acute care facility;
• and
• generating, for display, the report comprising a list of at least a subset of patients from the plurality of patients, where the list is ranked from the patient with the highest risk of readmission to the patient with the lowest risk of readmission.