用图结构提升病历推理中的患者类比效果,让大模型更准更稳。
GraphWalker: Patient Analogy Meets Information Gain for Clinical Reasoning with Large Language Models

- 构建患者图谱融合数据与模型视角,增强类比检索能力。
- 在多个真实病历数据集上超越现有方法,跨数据集泛化性强。
- 无需训练,可适配黑盒模型,适合集成到临床智能系统中。
电子健康记录(EHR)中的临床推理是现代医疗的核心挑战。尽管大语言模型(LLM)通过上下文示范实现零样本推理颇具前景,但现有基于患者类比的方法存在三大局限:(1)视角偏差,数据驱动的相似性与模型需求不匹配,而模型驱动信号受限于临床理解能力;(2)缺乏队列意识,示范选择独立进行,未建模人群结构;(3)信息聚合不足,忽视示范间的冗余与交互。我们提出GraphWalker,一种无需训练的框架,使冻结的LLM能通过检索患者病例进行类比推理。GraphWalker(i)联合使用数据与模型驱动视角,(ii)发现患者队列以支撑群体结构化的检索,(iii)采用懒惰贪心搜索与前沿扩展,生成具有高边际信息增益的示范组合。在多个真实世界EHR基准上的实验表明,GraphWalker持续优于最先进示范选择基线,在跨数据集分布偏移下仍保持显著鲁棒性,且无需任务特定参数更新。该方法还可推广至黑盒LLM,并自然集成到代理式推理框架中,可作为基于LLM的临床工作流中的可插拔患者类比技能。代码已开源:https://github.com/PuppyKnightUniversity/GraphWalker。
原文摘要 · Abstract (English)
Clinical reasoning over electronic health records (EHRs) is a fundamental yet challenging task in modern healthcare. While large language models (LLMs) offer a promising paradigm via in-context demonstrations that requires no task-specific parameter updates, existing methods for reasoning by patient analogy in EHR settings suffer from three core limitations: (1) Perspective Limitation, where data-driven similarity misaligns with LLM reasoning needs while model-driven signals are constrained by limited clinical competence; (2) Cohort Awareness, as demonstrations are selected independently without modeling population-level structure; and (3) Information Aggregation, where redundancy and interaction effects among demonstrations are ignored. We propose GraphWalker, a training-free framework that lets frozen LLMs reason by analogy over retrieved patient cases. GraphWalker (i) jointly leverages data-driven and model-driven perspectives, (ii) discovers patient cohorts to ground retrieval in population-level structure, and (iii) employs a lazy greedy search with frontier expansion to compose demonstrations with high marginal information gain. Extensive experiments on multiple real-world EHR benchmarks show that GraphWalker consistently outperforms state-of-the-art demonstration selection baselines, and remains substantially more robust under cross-dataset distribution shift, without task-specific parameter updates. GraphWalker further generalizes to black-box LLMs and composes naturally with agentic reasoning frameworks, positioning it as a pluggable patient-analogy skill in LLM-based clinical workflows. Our code is available at https://github.com/PuppyKnightUniversity/GraphWalker.
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