Factors determining the tele-consultation suitability for hepato-biliary diseases during the COVID-19 pandemic: A machine learning-based approach

Background: The suitability of teleconsultation is crucial for the effective delivery of health care services. Therefore, we evaluated the factors determining the suitability of teleconsultations for hepato-biliary diseases during the COVID-19 pandemic. Methods: In a prospective study conducted between March 2020 and January 2021, we asked the hepatologists delivering the tele-consultations in a tertiarycare center to fill a pre-validated questionnaire to assess the suitability of the given consult in real-time. The patient's sociodemographic and clinical details were noted. Patients were interviewed telephonically seven days after the consultation, and the level of understanding and hospitalization rate was assessed. A consult was deemed suitable when the physician reported its suitability in the absence of hospitalization. Factors determining the suitability of tele-consultations were evaluated on univariable analysis and machine learning models such as decision tree and extreme gradient boosting (XGB). Results: Of 1419 registrations, 1118 (87.2%) patients with male-gender (71%), age of 46 years (IQR: 18-68), and a rural background (72.7%) were analyzed. On univariable analysis, patients with skilled occupation, higher education, paying status, hepatitis B, C, and non-alcoholic fatty liver disease (NAFLD) were likely to be suitable (p<0.05). Patients with cirrhosis (compensated or decompensated), acute-on-chronic liver failure (ACLF), and biliary obstruction were likely unsuitable (p<0.05). A decision tree was developed from the significant variables on univariable analysis and important variables derived from the XGB-model. Patients with compensated cirrhosis who were educated or involved in a skilled occupation with an age of <55 years had a probability of 78% towards suitability. Hepatocellular carcinoma, decompensated cirrhosis, and ACLF patients were unsuitable with a probability of 60-95%. In non-cirrhotic liver diseases, hepatitis B, C, NAFLD were suitable with the probability of 89.7%. Extrahepatic biliary obstruction and previous failure of teleconsultation were unsuitable with a probability of 70%. Other tropical illnesses, extrahepatic portal venous obstruction, noncirrhotic portal fibrosis, dyspepsia, dysphagia not requiring any intervention were suitable with a probability of 88%. Conclusion: A simple decision tree can reliably guide physicians for conducting tele-consults for hepatobiliary diseases during the COVID-19 pandemic and beyond.