针对帕金森病用药推荐,提出可理解患者特性的智能检索框架。
PACE-RAG: Patient-Aware Contextual and Evidence-Constrained RAG for Clinical Drug Recommendation
- 基于患者临床特征检索相似病例,再结合当前症状细化处方。
- 在帕金森病和MIMIC-IV数据集上分别达到80.84%和47.22%的F1分数。
- 适合需要个性化、可解释临床决策支持的医生或研究者使用。
药物推荐需深入理解个体患者背景,尤其对帕金森病等复杂疾病而言。尽管大语言模型具备广泛医学知识,却难以捕捉实际用药中的细微差别。现有RAG方法也因基于指南的检索过于泛化,或相似患者检索重复主流用药模式,而忽略个体临床独特性。为此,我们提出患者感知型上下文与证据约束的RAG框架(PACE-RAG)。该方法不直接复制常见用药,而是先提取患者特异性临床特征,检索围绕这些特征的病例,再结合当前症状、用药史及特定药物倾向进行处方优化。通过分析特定临床特征下的治疗模式,PACE-RAG生成个性化用药建议并附可解释的临床摘要。在评估中,其表现优于其他仅推理的LLM方法,在帕金森病和MIMIC-IV数据集上的F1分数分别为80.84%和47.22%。代码已开源:https://github.com/ChaeYoungHuh/PACE-RAG。
原文摘要 · Abstract (English)
Drug recommendation requires a deep understanding of individual patient context, especially for complex conditions like Parkinson's disease. While LLMs possess broad medical knowledge, they fail to capture the subtle nuances of actual prescribing patterns. Existing RAG methods also struggle with these complexities because guideline-based retrieval remains too generic and similar-patient retrieval often replicates majority patterns without accounting for the unique clinical nuances of individual patients. To bridge this gap, we propose PACE-RAG (Patient-Aware Contextual and Evidence-Constrained RAG). Rather than directly copying frequent medications from retrieved patients, PACE-RAG personalizes recommendations by first extracting patient-specific clinical features, retrieving cases around these features, and then refining the final prescription using the patient's current symptoms, active medication history, and focus-specific prescribing tendencies. By analyzing treatment patterns tailored to specific clinical features, PACE-RAG generates patient-specific medication recommendations along with an explainable clinical summary. PACE-RAG achieved the strongest performance among the evaluated inference-only LLM-based methods, reaching F1 scores of 80.84% and 47.22% on the Parkinson's disease and MIMIC-IV cohorts, respectively. Our code is available at: https://github.com/ChaeYoungHuh/PACE-RAG.
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