Use of big data from health insurance for assessment of cardiovascular outcomes

Frontiers in Artificial Intelligence

Artificial Intelligence

Ulrich Güldener¹  Johann S. Hawe¹  Diana David-Rus¹  Partho Sen¹  Moritz von Scheidt²  Salvatore Cassese²  Johannes Krefting²  Heribert Schunkert² 

[1] Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany;Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany;German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany;

关键词: machine learning;    healthcare research;    health insurance claims;    prediction;    artificial intelligence;    big data;    prevention;   

DOI  :  10.3389/frai.2023.1155404

 received in 2023-02-24, accepted in 2023-04-13,  发布年份 2023

来源: Frontiers

【 摘 要 】

Outcome research that supports guideline recommendations for primary and secondary preventions largely depends on the data obtained from clinical trials or selected hospital populations. The exponentially growing amount of real-world medical data could enable fundamental improvements in cardiovascular disease (CVD) prediction, prevention, and care. In this review we summarize how data from health insurance claims (HIC) may improve our understanding of current health provision and identify challenges of patient care by implementing the perspective of patients (providing data and contributing to society), physicians (identifying at-risk patients, optimizing diagnosis and therapy), health insurers (preventive education and economic aspects), and policy makers (data-driven legislation). HIC data has the potential to inform relevant aspects of the healthcare systems. Although HIC data inherit limitations, large sample sizes and long-term follow-up provides enormous predictive power. Herein, we highlight the benefits and limitations of HIC data and provide examples from the cardiovascular field, i.e. how HIC data is supporting healthcare, focusing on the demographical and epidemiological differences, pharmacotherapy, healthcare utilization, cost-effectiveness and outcomes of different treatments. As an outlook we discuss the potential of using HIC-based big data and modern artificial intelligence (AI) algorithms to guide patient education and care, which could lead to the development of a learning healthcare system and support a medically relevant legislation in the future.

【 授权许可】

Unknown   
Copyright © 2023 Krefting, Sen, David-Rus, Güldener, Hawe, Cassese, von Scheidt and Schunkert.