通过融合多种因果算法,发现不同患者群体中反复不良健康事件的驱动因素。
Heterogeneous Causal Discovery of Repeated Undesirable Health Outcomes
- 整合多算法因果结构学习,提升因果推断稳健性。
- 识别出慢病管理和照护协调是关键干预措施。
- 结果可解释且适配临床决策,适合医疗数据研究者使用。
理解触发或阻止患者亚群中反复不良健康事件的因素,对设计精准干预至关重要。传统方法如随机对照试验和专家访谈耗时或不可行。因果发现可通过观测数据生成因果假设,但受限于强假设。本文提出一种端到端框架,融合多种因果结构学习(CSL)算法与异质因果效应估计。通过聚合多算法结果,识别出在不同假设下均稳定的因果关系,并揭示其在特定患者背景下的差异。该框架提升了鲁棒性,为实践者提供可行动、可解释的优先假设。我们在两个大规模医疗场景中验证:糖尿病患者重复急诊就诊与重症监护室患者再入院。基于保险理赔和电子健康记录数据,结果均表明慢病管理与照护协调是核心干预点,且干预效果依赖患者个体特征。采用多层验证策略——模拟真实数据恢复、文献一致性、临床专家验证及外部数据可迁移性——证明了该框架的实际价值。
原文摘要 · Abstract (English)
Understanding the factors that trigger or prevent undesirable health outcomes across patient subpopulations is essential for designing targeted interventions. While randomized controlled trials and expert-led patient interviews are standard methods for identifying these factors, they can be time-consuming or infeasible. Causal discovery offers an alternative to conventional approaches by generating cause-and-effect hypotheses from observational data, yet its practical utility is limited by strong or untestable assumptions. This work presents a novel, end-to-end framework that uniquely integrates an ensemble of causal structure learning (CSL) algorithms with heterogeneous causal effect estimation. By aggregating results across multiple algorithms, the framework identifies robust causal relationships that persist under different modeling assumptions while simultaneously revealing how these effects vary across specific patient contexts. The proposed heterogeneous causal discovery framework improves robustness and provides practitioners with a prioritized set of actionable, clinically interpretable hypotheses. We demonstrate the framework's effectiveness through two large-scale healthcare applications: identifying drivers and inhibitors of repeat emergency department visits among diabetic patients and hospital readmissions among ICU patients, using insurance claims and electronic health record datasets. Our results, across both settings, identify chronic disease management and care coordination as key interventions, while revealing that intervention effectiveness depends on specific patient-level modifiers. We employ a multi-layered validation strategy, including ground-truth recovery via simulations, alignment with clinical literature, validation by expert clinicians, and portability in modern healthcare systems using an external dataset, to demonstrate the framework's practical utility.
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