实现全球模型通用性:使用OHDSI网络对患者一级风险预测模型进行独立的跨站点特征评估
Behzad Naderalvojoud1, Catherine M Curtin2, Chen Yanover3
1Department of Medicine, Stanford University, Stanford, CA 94305, United States.
Journal of the American Medical Informatics Association : JAMIA
|February 27, 2024
概括
这项研究使用来自四个国家的电子健康记录开发了术后长期使用阿片类药物 (POU) 的可概括的预测模型. 跨站点特征选择在外部验证中显著改善了模型性能,提高了医疗保健模型的实用性.
科学领域:
- 医疗保健分析 医疗保健分析
- 机器学习在医学中的应用
- 预测建模预测建模
背景情况:
- 医疗保健中的预测模型面临普遍性挑战,限制了外部验证.
- 当前的验证方法往往限制了特征的使用,阻碍了对新站点的适用性评估.
- 提出了一种新的方法来评估在开发和验证期间的特性,以提高可通用性.
研究的目的:
- 开发和验证术后患者结果的可通用预测模型.
- 在模型开发和验证中引入用于特征评估的创新方法.
- 提高预测模型在外部临床场所部署的适用性.
主要方法:
- 使用了来自4个国家 (美国,英国,芬兰,韩国) 的电子健康记录 (EHR),将其映射到OMOP共同数据模型 (CDM).
- 开发了机器学习 (ML) 模型,使用手术前数据预测术后长期使用阿片类药物 (POU) 的风险.
- 应用了本地和跨站点特征选择方法,用于模型开发和使用OHDSI工具进行外部验证.
主要成果:
- 模型开发包括41,929名患者;外部验证涉及四个国家的65,000多名患者.
- 最顶级的模型,拉索逻辑回归,在局部验证中实现了0.75的AUROC,在外部验证中达到0.69 (平均值).
- 使用跨站点特征选择的模型在外部验证中显著优于仅使用开发站点特征的模型 (P < .05).
结论:
- 对POU开发了可通用的预测模型,使用映射到OMOP CDM的多国EHR数据.
- 跨站点的特征选择对改善预测模型性能产生了重大影响.
- 从各种临床环境中纳入各种特征对于提高医疗预测模型的通用性和实用性至关重要.
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