Department of Computer Science, University of Pittsburgh, Pittsburgh, PA, USA.
Artif Intell Med. 2023 Sep;143:102620. doi: 10.1016/j.artmed.2023.102620. Epub 2023 Jul 20.
Clinical event sequences consist of hundreds of clinical events that represent records of patient care in time. Developing accurate predictive models of such sequences is of a great importance for supporting a variety of models for interpreting/classifying the current patient condition, or predicting adverse clinical events and outcomes, all aimed to improve patient care. One important challenge of learning predictive models of clinical sequences is their patient-specific variability. Based on underlying clinical conditions, each patient's sequence may consist of different sets of clinical events (observations, lab results, medications, procedures). Hence, simple population-wide models learned from event sequences for many different patients may not accurately predict patient-specific dynamics of event sequences and their differences. To address the problem, we propose and investigate multiple new event sequence prediction models and methods that let us better adjust the prediction for individual patients and their specific conditions. The methods developed in this work pursue refinement of population-wide models to subpopulations, self-adaptation, and a meta-level model switching that is able to adaptively select the model with the best chance to support the immediate prediction. We analyze and test the performance of these models on clinical event sequences of patients in MIMIC-III database.
临床事件序列由数百个临床事件组成,这些事件代表了患者在时间上的护理记录。开发此类序列的准确预测模型对于支持多种模型来解释/分类当前患者状况或预测不良临床事件和结果非常重要,所有这些都是为了改善患者护理。学习临床序列预测模型的一个重要挑战是它们的患者特异性可变性。基于潜在的临床状况,每个患者的序列可能包含不同的临床事件集(观察结果、实验室结果、药物、程序)。因此,从许多不同患者的事件序列中学习的简单的人群范围模型可能无法准确预测患者特定的事件序列动态及其差异。为了解决这个问题,我们提出并研究了多个新的事件序列预测模型和方法,这些模型和方法可以让我们更好地调整对个体患者及其特定情况的预测。这项工作中开发的方法旨在将人群范围模型细化到亚人群,进行自我适应,以及元级别模型切换,能够自适应地选择最有机会支持即时预测的模型。我们在 MIMIC-III 数据库中的患者临床事件序列上分析和测试这些模型的性能。