Patent ID: 8694334

Claim:
One or more non-transitory computer storage media storing computer-useable instructions that, when used by one or more computing devices, cause the one or more computing devices to perform a method, the method comprising: accessing patient information for a first patient admitted or planned to be admitted to a healthcare facility; determining, based on the patient information, if each of a first set of risk factors is satisfied, the first set of risk factors including: (1) the first patient is being admitted within 30 days from a previous admission, (2) the first patient is diagnosed with one of a plurality of predetermined conditions, (3) the first patient's age is above a threshold age and the patient lives in social isolation, and (4) the first patient has a length of stay at the healthcare facility greater than a threshold length of stay; determining, based on the patient information, if each of a second set of risk factors is satisfied, the second set of risk factors including: (1) a number of emergency department visits for the first patient over a given time period exceeds a threshold number of emergency department visits, (2) a number of admissions for the first patient over a given time period exceeds a threshold number of admissions, (3) a comorbidity score for the first patient exceeds a comorbidity score threshold, (4) the first patient has a predetermined type of insurance, and (5) the first patient is being admitted to the intensive care unit; determining if at least one risk factor from the first set of risk factors has been satisfied or at least two risk factors from the second set of risk factors have been satisfied; if no risk factor from the first set of risk factors has been satisfied and no more than one risk factor from the second set of risk factors has been satisfied, identifying the first patent as not being at risk for readmission; and if at least one risk factor from the first set of risk factors has been satisfied or if at least two risk factors from the second set of risk factors has been satisfied, identifying the first patient as being at risk for readmission and including the first patient in a user interface for presentation that facilitates managing a plurality of patients identified as being at risk for readmission.