arXiv:2504.17277cs.LGcs.AI2025-04中稿 · the Conference on …

用可解释的离线学习法优化重症患者化验单,减少冗余检查。

ExOSITO: Explainable Off-Policy Learning with Side Information for Intensive Care Unit Blood Test Orders

  • 结合临床先验知识与观测数据,构建可解释的离线策略
  • 在真实医疗数据上降低化验成本,同时不遗漏关键检测
  • 适合关注临床决策支持与医疗资源优化的研究者

在重症监护室(ICU)中,如何为患者选择最少但最有效的化验项目仍具挑战性。医护团队需在获取必要信息与减轻检查负担及成本之间取得平衡。当前大多数住院场景存在频繁过度开单现象,亟需减少对医院资源与环境的影响。本文提出一种新方法——基于侧信息的可解释离线学习(ExOSITO),通过因果多臂老虎机框架,利用离线数据与符合临床规范的奖励函数,融合临床知识与观测数据,弥合最优策略与记录策略之间的差距。该方法生成的策略能提供可解释的临床建议,在不遗漏任何关键化验的前提下,显著降低开单成本,优于医生现有做法与现有方法。

原文摘要 · Abstract (English)

Ordering a minimal subset of lab tests for patients in the intensive care unit (ICU) can be challenging. Care teams must balance between ensuring the availability of the right information and reducing the clinical burden and costs associated with each lab test order. Most in-patient settings experience frequent over-ordering of lab tests, but are now aiming to reduce this burden on both hospital resources and the environment. This paper develops a novel method that combines off-policy learning with privileged information to identify the optimal set of ICU lab tests to order. Our approach, EXplainable Off-policy learning with Side Information for ICU blood Test Orders (ExOSITO) creates an interpretable assistive tool for clinicians to order lab tests by considering both the observed and predicted future status of each patient. We pose this problem as a causal bandit trained using offline data and a reward function derived from clinically-approved rules; we introduce a novel learning framework that integrates clinical knowledge with observational data to bridge the gap between the optimal and logging policies. The learned policy function provides interpretable clinical information and reduces costs without omitting any vital lab orders, outperforming both a physician's policy and prior approaches to this practical problem.

医疗决策离线学习可解释性重症监护

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