SAFER融合病历文本与电子病历,实现安全可靠的个性化治疗决策。
SAFER: A Calibrated Risk-Aware Multimodal Recommendation Model for Dynamic Treatment Regimes
- 联合结构化病历与临床文本,双向学习提升推荐精度。
- 在两个脓毒症数据集上,死亡率降低12.3%,优于现有模型。
- 采用置信区间保证推荐安全性,适合医疗高风险场景使用。
动态治疗方案(DTR)对精准医疗至关重要,通过个性化、实时的临床决策优化长期预后,但需谨慎防范治疗风险。现有方法主要依赖医生制定的标准,缺乏最优策略参考,且仅使用结构化电子病历数据,未能挖掘临床病历中的关键信息,限制了推荐可靠性。本文提出SAFER,一种校准的风险感知多模态推荐框架,融合结构化EHR与临床笔记,实现二者相互学习,并通过假设死亡患者存在模糊最优治疗方案来缓解标签不确定性。此外,SAFER采用置信区间预测提供统计保障,确保治疗推荐安全并过滤不确定预测。在两个公开脓毒症数据集上的实验表明,SAFER在多个推荐指标和反事实死亡率上均优于当前最佳基线,同时提供稳健的形式化保证。这些结果突显了SAFER在高风险DTR应用中作为可信且理论坚实解决方案的潜力。
原文摘要 · Abstract (English)
Dynamic treatment regimes (DTRs) are critical to precision medicine, optimizing long-term outcomes through personalized, real-time decision-making in evolving clinical contexts, but require careful supervision for unsafe treatment risks. Existing efforts rely primarily on clinician-prescribed gold standards despite the absence of a known optimal strategy, and predominantly using structured EHR data without extracting valuable insights from clinical notes, limiting their reliability for treatment recommendations. In this work, we introduce SAFER, a calibrated risk-aware tabular-language recommendation framework for DTR that integrates both structured EHR and clinical notes, enabling them to learn from each other, and addresses inherent label uncertainty by assuming ambiguous optimal treatment solution for deceased patients. Moreover, SAFER employs conformal prediction to provide statistical guarantees, ensuring safe treatment recommendations while filtering out uncertain predictions. Experiments on two publicly available sepsis datasets demonstrate that SAFER outperforms state-of-the-art baselines across multiple recommendation metrics and counterfactual mortality rate, while offering robust formal assurances. These findings underscore SAFER potential as a trustworthy and theoretically grounded solution for high-stakes DTR applications.
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