用分通道深度学习模型,提升复杂患者群体的医疗费用预测准确率。
Healthcare cost prediction for heterogeneous patient profiles using deep learning models with administrative claims data
- 按诊断、操作等类型拆分医保数据为多通道,降低异质性影响
- 相比单通道模型,预测误差降低23%,高需求患者误判减少超16%
- 适合需精准控费的医保机构或保险公司,尤其关注慢性病患者
问题:如何设计能有效应对医保数据异质性挑战的患者费用预测模型,以实现对高需求(HN)复杂慢性病患者的准确、公平且可泛化的预测?相关性:准确且公平的费用预测对制定健康政策和优化资源配置至关重要,可为政府与私营保险公司带来显著成本节约。解决高需求患者预测偏差,有助于改善经济与临床决策。方法:本研究结合社会技术视角,强调技术系统(如深度学习模型)与人文结果(如医疗决策公平性)的互动。采用表示学习与熵测量,处理数据与患者特征的异质性与复杂性。提出一种通道式深度学习框架,将医保数据按代码类型(如诊断、操作)和费用拆分为独立通道。搭配多通道熵测量评估患者异质性。结果:所提通道式模型相比单通道模型,预测误差降低23%,过付与少付分别减少16.4%和19.3%。高需求患者预测偏差下降尤为显著,证明其在应对数据与患者特征复杂性方面的有效性。该方法适用于存在类似异质性挑战的领域。
原文摘要 · Abstract (English)
Problem: How can we design patient cost prediction models that effectively address the challenges of heterogeneity in administrative claims (AC) data to ensure accurate, fair, and generalizable predictions, especially for high-need (HN) patients with complex chronic conditions? Relevance: Accurate and equitable patient cost predictions are vital for developing health management policies and optimizing resource allocation, which can lead to significant cost savings for healthcare payers, including government agencies and private insurers. Addressing disparities in prediction outcomes for HN patients ensures better economic and clinical decision-making, benefiting both patients and payers. Methodology: This study is grounded in socio-technical considerations that emphasize the interplay between technical systems (e.g., deep learning models) and humanistic outcomes (e.g., fairness in healthcare decisions). It incorporates representation learning and entropy measurement to address heterogeneity and complexity in data and patient profiles, particularly for HN patients. We propose a channel-wise deep learning framework that mitigates data heterogeneity by segmenting AC data into separate channels based on types of codes (e.g., diagnosis, procedures) and costs. This approach is paired with a flexible evaluation design that uses multi-channel entropy measurement to assess patient heterogeneity. Results: The proposed channel-wise models reduce prediction errors by 23% compared to single-channel models, leading to 16.4% and 19.3% reductions in overpayments and underpayments, respectively. Notably, the reduction in prediction bias is significantly higher for HN patients, demonstrating effectiveness in handling heterogeneity and complexity in data and patient profiles. This demonstrates the potential for applying channel-wise modeling to domains with similar heterogeneity challenges.
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