用多模态模型自动预警住院患者恶化风险,提升医护效率。
Early Warning Index for Patient Deteriorations in Hospitals
- 融合结构化与非结构化病历数据,结合临床反馈构建可解释风险模型
- 在1.86万患者数据上实现0.796的C统计值,分层预警三类危急事件
- 通过可解释性分析定位风险因素,辅助资源调度与早期干预
医院缺乏自动化系统来整合日益增长的异构临床与运营数据以有效预测重大事件。早期识别高风险患者不仅关乎医疗质量监控,也影响医生管理效率。然而,因数据格式不一,将多元数据流转化为准确且可解释的风险评估面临挑战。我们提出一种多模态机器学习框架——早期预警指数(EWI),用于预测转入ICU、紧急响应团队出动及死亡的综合风险。EWI设计核心是人机协同:临床医生参与设定警报阈值并解读模型输出,结合SHAP可解释性技术突出显示驱动个体风险的临床与运营因素(如计划手术、病房人数)。我们在一家大型美国医院部署了该系统,通过仪表盘将患者分为三类风险等级。基于包含18,633名患者的数据库,模型自动从电子健康记录(EHR)中提取特征,达到0.796的C-statistics。目前作为分诊工具,主动管理高风险患者。该方法节省医生时间,使其聚焦于患者照护而非复杂数据筛查;同时通过精准识别风险驱动因素,支持护理排班优化与关键资源调配,从而降低后续并发症、昂贵治疗及高再入院率,改善整体患者流转。
原文摘要 · Abstract (English)
Hospitals lack automated systems to harness the growing volume of heterogeneous clinical and operational data to effectively forecast critical events. Early identification of patients at risk for deterioration is essential not only for patient care quality monitoring but also for physician care management. However, translating varied data streams into accurate and interpretable risk assessments poses significant challenges due to inconsistent data formats. We develop a multimodal machine learning framework, the Early Warning Index (EWI), to predict the aggregate risk of ICU admission, emergency response team dispatch, and mortality. Key to EWI's design is a human-in-the-loop process: clinicians help determine alert thresholds and interpret model outputs, which are enhanced by explainable outputs using Shapley Additive exPlanations (SHAP) to highlight clinical and operational factors (e.g., scheduled surgeries, ward census) driving each patient's risk. We deploy EWI in a hospital dashboard that stratifies patients into three risk tiers. Using a dataset of 18,633 unique patients at a large U.S. hospital, our approach automatically extracts features from both structured and unstructured electronic health record (EHR) data and achieves C-statistics of 0.796. It is currently used as a triage tool for proactively managing at-risk patients. The proposed approach saves physicians valuable time by automatically sorting patients of varying risk levels, allowing them to concentrate on patient care rather than sifting through complex EHR data. By further pinpointing specific risk drivers, the proposed model provides data-informed adjustments to caregiver scheduling and allocation of critical resources. As a result, clinicians and administrators can avert downstream complications, including costly procedures or high readmission rates and improve overall patient flow.
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