论文标题

蒸馏以增强具有大量患者索赔数据库的机构之间风险模型的可移植性

Distillation to Enhance the Portability of Risk Models Across Institutions with Large Patient Claims Database

论文作者

Nyemba, Steve, Yan, Chao, Zhang, Ziqi, Rajmane, Amol, Meyer, Pablo, Chakraborty, Prithwish, Malin, Bradley

论文摘要

人工智能,尤其是机器学习(ML),越来越多地开发和部署,以支持各种环境中的医疗保健。但是,如果要大规模采用基于ML的临床决策支持(CDS)技术,则需要便携。在这方面,在一个机构开发的模型应在另一个机构中重复使用。然而,有许多可移植性故障的例子,尤其是由于ML模型的天真应用。可移植性失败会导致次优护理和医疗错误,这最终可以阻止在实践中采用基于ML的CD。可以从增强便携性中受益的一个特定医疗挑战是预测30天的再入院风险。迄今为止的研究表明,深度学习模型可以有效地建模这种风险。在这项工作中,我们通过对重新预测模型的跨站点评估来研究模型可移植性的实用性。为此,我们应用了一个经常性的神经网络,增强了自我注意事项并与专家功能融合在一起,为两个独立的大型索赔数据集构建了重新启动预测模型。我们进一步提出了一种新颖的转移学习技术,该技术适应了著名的重度网络(BAN)培训方法。我们的实验表明,在一个机构训练并在另一家机构进行测试的ML模型的直接应用比在同一机构训练和测试的模型要差。我们进一步表明,基于禁令的转移学习方法产生的模型比仅在一个机构的数据上接受培训的模型要好。值得注意的是,这种改进在两个站点之间都是一致的,并且在一次重新培训之后发生,这说明了廉价且通用模型转移风险预测的潜力。

Artificial intelligence, and particularly machine learning (ML), is increasingly developed and deployed to support healthcare in a variety of settings. However, clinical decision support (CDS) technologies based on ML need to be portable if they are to be adopted on a broad scale. In this respect, models developed at one institution should be reusable at another. Yet there are numerous examples of portability failure, particularly due to naive application of ML models. Portability failure can lead to suboptimal care and medical errors, which ultimately could prevent the adoption of ML-based CDS in practice. One specific healthcare challenge that could benefit from enhanced portability is the prediction of 30-day readmission risk. Research to date has shown that deep learning models can be effective at modeling such risk. In this work, we investigate the practicality of model portability through a cross-site evaluation of readmission prediction models. To do so, we apply a recurrent neural network, augmented with self-attention and blended with expert features, to build readmission prediction models for two independent large scale claims datasets. We further present a novel transfer learning technique that adapts the well-known method of born-again network (BAN) training. Our experiments show that direct application of ML models trained at one institution and tested at another institution perform worse than models trained and tested at the same institution. We further show that the transfer learning approach based on the BAN produces models that are better than those trained on just a single institution's data. Notably, this improvement is consistent across both sites and occurs after a single retraining, which illustrates the potential for a cheap and general model transfer mechanism of readmission risk prediction.

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