# An Integrated Framework for Explainable, Fair, and Observable Hospital Readmission Prediction: Development and Validation on MIMIC-IV

arXiv: https://arxiv.org/abs/2604.22535 · HTML: https://mlsanity.com/paper/2604.22535/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 4 of its 23 references that are in the map.
- First posted on arXiv 24 Apr 2026.

## Builds on (most cited first, 4 of 4)

- [A Unified Approach to Interpreting Model Predictions](https://mlsanity.com/paper/1705.07874/) (2017)
- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [Equality of Opportunity in Supervised Learning](https://mlsanity.com/paper/1610.02413/) (2016)
- [What Clinicians Want: Contextualizing Explainable Machine Learning for Clinical End Use](https://mlsanity.com/paper/1905.05134/) (2019)

## Abstract (arXiv)

Objective: To propose and retrospectively validate an integrated framework addressing three barriers to clinical translation of readmission prediction: lack of explainability, absence of deployment reliability infrastructure, and inadequate demographic fairness evaluation. Materials and Methods: We constructed a cohort of 415231 adult admissions from the MIMIC-IV database (30-day readmission prevalence 18.0%), split 70/15/15. Logistic regression, XGBoost, and LightGBM models were trained on 26 features. SHAP provided per-patient explanations. Fairness was evaluated across 16 subgroups using AUC-ROC, false negative rate (FNR), and positive predictive value (PPV). Calibration was assessed using Brier scores and calibration curves. Results: XGBoost achieved AUC-ROC 0.696 (95% CI 0.691-0.701), outperforming or matching the LACE baseline (AUC 0.60-0.68). LightGBM achieved best calibration (Brier 0.146). Prior admissions were the dominant predictor. All subgroups met equity thresholds (delta AUC <= 0.05, delta FNR <= 0.10). Conclusion: This framework delivers competitive performance, clinically actionable explanations, and strong demographic equity. Code is publicly available at https://github.com/Tomisin92/readmission-prediction.