arXiv:2603.07900cs.AI2026-03被引 2

让病历模型直接回答临床问题,零样本预测更准更快。

EveryQuery: Zero-Shot Clinical Prediction via Task-Conditioned Pretraining over Electronic Health Records

  • 用结构化问题+病史直接预测结果,一次前向传播完成
  • 在MIMIC-IV上82%任务表现超越基线,平均AUC提升0.16
  • 特别擅长罕见病预测,适合临床快速决策场景

基于电子健康记录(EHR)预训练的基础模型可通过生成合成患者未来轨迹并统计分析来实现零样本临床预测。然而,这种自回归推理过程计算成本高、统计噪声大,且无法原生支持用户通过具体临床问题进行条件化预测。本文提出EveryQuery,一种通过任务条件化预训练实现零样本推理的EHR基础模型。不同于生成未来事件,EveryQuery输入患者历史与结构化查询任务,通过单次前向传播直接估计未来窗口内结局发生的概率。该能力通过在随机采样的任务与患者上下文组合上预训练实现,使模型能对任意提示输出正确答案。这使得无需微调、线性探测或轨迹生成即可实现查询空间内任意任务的零样本预测。在MIMIC-IV数据集上,EveryQuery在39个随机采样任务中82%的表现优于自回归基线,平均AUC提升+0.16(95%置信区间:[0.10, 0.22]),且在预训练分布外的任务上仍保持优势。性能提升尤其显著于低发生率事件,验证了其对自回归推理在稀有结局上的根本性改进。但当前查询语言对多代码析取推理任务(如30天再入院)仍表现不佳,暴露了查询语言的表达力局限。

原文摘要 · Abstract (English)

Foundation models pretrained on electronic health records (EHR) have demonstrated zero-shot clinical prediction capabilities by generating synthetic patient futures and aggregating statistics over sampled trajectories. However, this autoregressive inference procedure is computationally expensive, statistically noisy, and not natively promptable because users cannot directly condition predictions on specific clinical questions. In this preliminary work, we introduce EveryQuery, an EHR foundation model that achieves zero-shot inference through task-conditioned pre-training. Rather than generating future events, EveryQuery takes as input a patient's history and a structured query specifying a clinical task, and directly estimates the likelihood of the outcome occurring in the future window via a single forward pass. EveryQuery realizes this capability by pre-training over randomly sampled combinations of query tasks and patient contexts, directly training the model to produce correct answers to arbitrary input prompts. This enables zero-shot prediction for any task in the query space without finetuning, linear probing, or trajectory generation. On MIMIC-IV, EveryQuery outperforms an autoregressive baseline on 82% of 39 randomly sampled prediction tasks, with a mean AUC improvement of +0.16 (95% CI: [0.10,0.22]). This advantage remains consistent on tasks that were explicitly held out from the pre-training distribution. Further, EveryQuery's performance gains are most pronounced for rare clinical events, affirming and demonstrating a solution to the fundamental limitation of autoregressive inference for low-prevalence outcomes. However, at present, EveryQuery underperforms on tasks requiring disjunctive reasoning over multiple codes, such as 30-day readmission, exposing a concrete expressiveness limitation of the current query language.

临床预测零样本EHR模型任务条件化

Thank you to arXiv for use of its open access interoperability. PaperDance 不是 arXiv 官方产品;中文卡片由大模型生成,请以原文为准。