Cooper Gregory F, Abraham Vijoy, Aliferis Constantin F, Aronis John M, Buchanan Bruce G, Caruana Richard, Fine Michael J, Janosky Janine E, Livingston Gary, Mitchell Tom, Monti Stefano, Spirtes Peter
Center for Biomedical Informatics, University of Pittsburgh, Suite 8084 Forbes Tower, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
J Biomed Inform. 2005 Oct;38(5):347-66. doi: 10.1016/j.jbi.2005.02.005. Epub 2005 Mar 17.
Community-acquired pneumonia (CAP) is an important clinical condition with regard to patient mortality, patient morbidity, and healthcare resource utilization. The assessment of the likely clinical course of a CAP patient can significantly influence decision making about whether to treat the patient as an inpatient or as an outpatient. That decision can in turn influence resource utilization, as well as patient well being. Predicting dire outcomes, such as mortality or severe clinical complications, is a particularly important component in assessing the clinical course of patients. We used a training set of 1601 CAP patient cases to construct 11 statistical and machine-learning models that predict dire outcomes. We evaluated the resulting models on 686 additional CAP-patient cases. The primary goal was not to compare these learning algorithms as a study end point; rather, it was to develop the best model possible to predict dire outcomes. A special version of an artificial neural network (NN) model predicted dire outcomes the best. Using the 686 test cases, we estimated the expected healthcare quality and cost impact of applying the NN model in practice. The particular, quantitative results of this analysis are based on a number of assumptions that we make explicit; they will require further study and validation. Nonetheless, the general implication of the analysis seems robust, namely, that even small improvements in predictive performance for prevalent and costly diseases, such as CAP, are likely to result in significant improvements in the quality and efficiency of healthcare delivery. Therefore, seeking models with the highest possible level of predictive performance is important. Consequently, seeking ever better machine-learning and statistical modeling methods is of great practical significance.
社区获得性肺炎(CAP)在患者死亡率、发病率以及医疗资源利用方面是一种重要的临床病症。对CAP患者可能的临床病程进行评估,会显著影响关于将患者作为住院患者还是门诊患者进行治疗的决策。而这一决策反过来又会影响资源利用以及患者的健康状况。预测诸如死亡率或严重临床并发症等不良后果,是评估患者临床病程的一个特别重要的组成部分。我们使用了1601例CAP患者病例的训练集来构建11个预测不良后果的统计和机器学习模型。我们在另外686例CAP患者病例上对所得模型进行了评估。主要目标并非将这些学习算法作为研究终点进行比较;相反,是要开发出尽可能最佳的预测不良后果的模型。一种特殊版本的人工神经网络(NN)模型对不良后果的预测效果最佳。利用这686个测试病例,我们估计了在实际应用NN模型时预期的医疗质量和成本影响。该分析的具体定量结果基于我们明确提出的一些假设;它们需要进一步研究和验证。尽管如此,该分析的总体含义似乎是可靠的,即对于诸如CAP等常见且代价高昂的疾病,即使预测性能有微小提升,也可能会显著提高医疗服务的质量和效率。因此,寻求具有尽可能高预测性能水平的模型非常重要。相应地,寻求更好的机器学习和统计建模方法具有重大的实际意义。