Abstract Details

Title A Claims-based Machine Learning Model to Classify Modified Rankin Scale at Stroke Discharge

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P6 - Poster Session 6 (11:45 AM-12:45 PM)

Poster/Presentation
Number 14-012

Objective We validated a Medicare claims-based classifier to assess stroke severity, as measured by the Modified Rankin Scale (mRS) at discharge, among Medicare beneficiaries hospitalized for acute ischemic stroke (AIS).

Background The modified Rankin Scale (mRS) has been widely used to assess the severity of AIS in electronic health records (EHRs) and registries. However, national large-scale claims-based studies have been limited by the lack of valid measures of stroke severity.

Design/Methods We linked Paul Coverdell National Acute Stroke Program (PCNASP) to Medicare Claims data and sampled AIS patients aged 65+ admitted from 01/2018 to 12/2020 across nine states. PCNASP was primarily used to extract the outcome, discharge mRS, while the variables for the classifier were derived from Medicare claims data. Hospitals with an mRS completion rate below 90% were assigned to the training set, while those with 90%+ were assigned to the test set. A random 20% sample from hospitals with 90%+ completion was added to the training set for representativeness. Binary logistic regression with Lasso penalty classified discharge mRS, dichotomized as ≤2 for favorable and >2 for unfavorable outcomes. The classifier was evaluated on the test set using metrics like ROC AUC, Precision-Recall AUC and sensitivity.

Results The sample included 68,636 patients (mean [sd] age: 79.5 [8.7], female: 37,439 (54.5%)), with 27,986 (mean [sd] age: 79.8 [8.71], female: 15,394 (55.0%)) in the testing set. The predictors included 63 features, such as demographics, medical history, treatments, and discharge outcomes. The classifier achieved an ROC AUC of 0.85 (95%CI: 0.85 – 0.86), Sensitivity of 0.90 (95%CI: 0.90 – 0.91), Precision-Recall AUC of 0.90 (95%CI: 0.90 – 0.91).

Conclusions Among Medicare beneficiaries hospitalized for AIS, the claims-based classifier demonstrated excellent performance in ROC AUC, Precision-Recall AUC, and sensitivity for mRS classification. These results configure it as a tool for national surveillance of stroke outcomes.

Authors/Disclosures
Mamoon Habib PRESENTER	Mamoon Habib has nothing to disclose.
Rafaella Cazé de Medeiros, MD	Miss Cazé de Medeiros has nothing to disclose.
Syed Muhammad Ahsan, MD, MBBS	Dr. Ahsan has nothing to disclose.
Aidan McDonald Wojciechowski	Mr. McDonald Wojciechowski has nothing to disclose.
Joseph Newhouse (Harvard University)	Joseph Newhouse has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for National Committee for Quality Assurance. Joseph Newhouse has received publishing royalties from a publication relating to health care.
M. B. Westover, MD, PhD (MGH)	Dr. Westover has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Beacon Biosignals. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities.
Lee H. Schwamm, MD, FAAN (Yale New Haven Health System)	Dr. Schwamm has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Prime ��ɫ��. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for lifeimage. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for mediasphere. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for medscape/WebMD. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Penumbra. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. The institution of Dr. Schwamm has received research support from NINDS. The institution of Dr. Schwamm has received research support from PCORI. Dr. Schwamm has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Schwamm has received publishing royalties from a publication relating to health care. Dr. Schwamm has a non-compensated relationship as a Board of directors with American heart association that is relevant to AAN interests or activities.
Lidia Maria V. Moura, MD, PhD, MPH, FAAN (Massachusetts General Hospital)	Dr. Moura has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Moura has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. The institution of Dr. Moura has received research support from Centers for Diseases Control and Prevention (CDC SIP20-007) . The institution of Dr. Moura has received research support from Epilepsy Foundation of America . The institution of Dr. Moura has received research support from NIH - NIA and NINDS. Dr. Moura has received personal compensation in the range of $50,000-$99,999 for serving as a Expert Advisor with Epilepsy Foundation .

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