arXiv:2503.03724stat.MLcs.AI2025-03

用深度学习挖掘医疗行为决策中的因果关系,帮医生选最优治疗方案。

Deep Causal Behavioral Policy Learning: Applications to Healthcare

  • 基于Transformer构建临床行为模型,学习高维诊疗路径分布
  • 识别医生行为对患者结局的因果影响,找到最佳匹配医生类型
  • 可解释为隐性临床知识编码,适合临床决策支持系统应用

我们提出一种基于深度学习的方法——深度因果行为策略学习(DC-BPL),用于研究非随机化医疗环境中的动态临床行为策略。该方法利用深度学习算法学习高维临床行为路径的分布,并识别这些路径与患者结果之间的因果关联。具体包括:(1) 识别医生分配对临床结果的因果效应;(2) 学习特定医生在患者信息动态变化下的临床行为分布;(3) 结合上述步骤,为特定患者类型识别最优医生并模拟其诊疗决策。为此,我们在电子健康记录数据上使用Transformer架构训练了一个大型临床行为模型(LCBM),证明其能有效估计临床行为策略。我们提出一种新解释:通过LCBM学习到的行为策略是复杂、常为隐性的临床知识的高效编码,这些知识大多通过多年实践积累,仅极小部分被写入教材、研究或标准指南中。该方法可构建广泛应用于医疗场景的关键策略空间。

原文摘要 · Abstract (English)

We present a deep learning-based approach to studying dynamic clinical behavioral regimes in diverse non-randomized healthcare settings. Our proposed methodology - deep causal behavioral policy learning (DC-BPL) - uses deep learning algorithms to learn the distribution of high-dimensional clinical action paths, and identifies the causal link between these action paths and patient outcomes. Specifically, our approach: (1) identifies the causal effects of provider assignment on clinical outcomes; (2) learns the distribution of clinical actions a given provider would take given evolving patient information; (3) and combines these steps to identify the optimal provider for a given patient type and emulate that provider's care decisions. Underlying this strategy, we train a large clinical behavioral model (LCBM) on electronic health records data using a transformer architecture, and demonstrate its ability to estimate clinical behavioral policies. We propose a novel interpretation of a behavioral policy learned using the LCBM: that it is an efficient encoding of complex, often implicit, knowledge used to treat a patient. This allows us to learn a space of policies that are critical to a wide range of healthcare applications, in which the vast majority of clinical knowledge is acquired tacitly through years of practice and only a tiny fraction of information relevant to patient care is written down (e.g. in textbooks, studies or standardized guidelines).

医疗决策因果学习行为策略Transformer

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