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      Demand prediction of medical services in home and community-based services for older adults in China using machine learning

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          Abstract

          Background

          Home and community-based services are considered an appropriate and crucial caring method for older adults in China. However, the research examining demand for medical services in HCBS through machine learning techniques and national representative data has not yet been carried out. This study aimed to address the absence of a complete and unified demand assessment system for home and community-based services.

          Methods

          This was a cross-sectional study conducted on 15,312 older adults based on the Chinese Longitudinal Healthy Longevity Survey 2018. Models predicting demand were constructed using five machine-learning methods: Logistic regression, Logistic regression with LASSO regularization, Support Vector Machine, Random Forest, and Extreme Gradient Boosting (XGboost), and based on Andersen's behavioral model of health services use. Methods utilized 60% of older adults to develop the model, 20% of the samples to examine the performance of models, and the remaining 20% of cases to evaluate the robustness of the models. To investigate demand for medical services in HCBS, individual characteristics such as predisposing, enabling, need, and behavior factors constituted four combinations to determine the best model.

          Results

          Random Forest and XGboost models produced the best results, in which both models were over 80% at specificity and produced robust results in the validation set. Andersen's behavioral model allowed for combining odds ratio and estimating the contribution of each variable of Random Forest and XGboost models. The three most critical features that affected older adults required medical services in HCBS were self-rated health, exercise, and education.

          Conclusion

          Andersen's behavioral model combined with machine learning techniques successfully constructed a model with reasonable predictors to predict older adults who may have a higher demand for medical services in HCBS. Furthermore, the model captured their critical characteristics. This method predicting demands could be valuable for the community and managers in arranging limited primary medical resources to promote healthy aging.

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          Most cited references72

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          SMOTE: Synthetic Minority Over-sampling Technique

          An approach to the construction of classifiers from imbalanced datasets is described. A dataset is imbalanced if the classification categories are not approximately equally represented. Often real-world data sets are predominately composed of ``normal'' examples with only a small percentage of ``abnormal'' or ``interesting'' examples. It is also the case that the cost of misclassifying an abnormal (interesting) example as a normal example is often much higher than the cost of the reverse error. Under-sampling of the majority (normal) class has been proposed as a good means of increasing the sensitivity of a classifier to the minority class. This paper shows that a combination of our method of over-sampling the minority (abnormal) class and under-sampling the majority (normal) class can achieve better classifier performance (in ROC space) than only under-sampling the majority class. This paper also shows that a combination of our method of over-sampling the minority class and under-sampling the majority class can achieve better classifier performance (in ROC space) than varying the loss ratios in Ripper or class priors in Naive Bayes. Our method of over-sampling the minority class involves creating synthetic minority class examples. Experiments are performed using C4.5, Ripper and a Naive Bayes classifier. The method is evaluated using the area under the Receiver Operating Characteristic curve (AUC) and the ROC convex hull strategy.
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            XGBoost

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              Scikit-learn : machine learning in Python

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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                16 March 2023
                2023
                : 11
                : 1142794
                Affiliations
                [1] 1School of Public Health and Management, Wenzhou Medical University, Wenzhou , Zhejiang, China
                [2] 2The State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling Network, School of Life Sciences, Xiamen University , Xiamen, China
                [3] 3Center for Healthy China Research, Wenzhou Medical University, Wenzhou , Zhejiang, China
                Author notes

                Edited by: P. Wilner Jeanty, OhioHealth, United States

                Reviewed by: Jutatip Sillabutra, Mahidol University, Thailand; Qiutong Yu, Shandong University, China

                *Correspondence: Chun Chen chenchun408@ 123456126.com

                This article was submitted to Health Economics, a section of the journal Frontiers in Public Health

                †These authors have contributed equally to this work

                Article
                10.3389/fpubh.2023.1142794
                10060662
                72ba11c4-06cc-4402-bafc-0e61ea5bd044
                Copyright © 2023 Huang, Xu, Yang, Pan, Zhan, Chen, Zhang and Chen.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 12 January 2023
                : 28 February 2023
                Page count
                Figures: 2, Tables: 3, Equations: 4, References: 77, Pages: 10, Words: 8191
                Funding
                This work was supported by National Natural Science Foundation of China [72274141], Zhejiang Provincial Natural Science Foundation [LY22G030006], Philosophy and Social Science Project of Zhejiang Province, China [22NDJC104YB], Zhejiang Provincial Science and Technology Innovation Program (New Young Talent Program) for College Students [2022R413B053], and Scientific Research Fund of Zhejiang Provincial Education Department [Y202147813].
                Categories
                Public Health
                Original Research

                home and community-based services,andersen's behavioral model,chinese longitudinal healthy longevity survey,demand prediction model,machine learning

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