用分层注意力模型精准预测慢性肾病,还能解释每项医疗数据的作用。
Interpretable Hierarchical Attention Network for Medical Condition Identification
- 分三层注意力分析医疗编码、就诊记录和具体诊断,匹配真实诊疗顺序。
- 在三年医保数据上预测3期慢性肾病,性能优于传统模型。
- 输出可解释的贡献度,帮助医生理解预测依据,适合临床辅助决策。
基于历史临床证据准确预测医疗状况是医疗管理与健康保险领域的长期目标。尽管机器学习取得进展,医学界仍对模型准确性和可解释性存疑。本文提出一种可解释的分层注意力网络(IHAN),通过三层次注意力机制——分别关注诊断码、操作码、检验结果和处方药类型;同一类型内的就诊序列;以及每次就诊中的具体医疗代码——自然匹配患者诊疗记录的时间结构。该模型以美国全国性健康保险公司医保优势计划(MA)成员为期三年的医疗记录(包括理赔和电子病历数据)为输入,预测3期慢性肾病(CKD)的发生,并计算各医疗事件对预测结果的贡献度。
原文摘要 · Abstract (English)
Accurate prediction of medical conditions with straight past clinical evidence is a long-sought topic in the medical management and health insurance field. Although great progress has been made with machine learning algorithms, the medical community is still skeptical about the model accuracy and interpretability. This paper presents an innovative hierarchical attention deep learning model to achieve better prediction and clear interpretability that can be easily understood by medical professionals. This paper developed an Interpretable Hierarchical Attention Network (IHAN). IHAN uses a hierarchical attention structure that matches naturally with the medical history data structure and reflects patients encounter (date of service) sequence. The model attention structure consists of 3 levels: (1) attention on the medical code types (diagnosis codes, procedure codes, lab test results, and prescription drugs), (2) attention on the sequential medical encounters within a type, (3) attention on the individual medical codes within an encounter and type. This model is applied to predict the occurrence of stage 3 chronic kidney disease (CKD), using three years medical history of Medicare Advantage (MA) members from an American nationwide health insurance company. The model takes members medical events, both claims and Electronic Medical Records (EMR) data, as input, makes a prediction of stage 3 CKD and calculates contribution from individual events to the predicted outcome.
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