一种混合强化学习和知识图框架,用于医疗保健系统的财务风险优化
Md Shahab Uddin1, Ahsan Ahmed2, Md Aktarujjaman3
1Department of Computer Science, Maharishi International University, Fairfield, IA, 52557, USA.
Scientific reports
|August 9, 2025
概括
本研究介绍了一种混合人工智能框架,使用强化学习和知识图来优化医疗保健计费,提高成本效益,同时保持诊断准确性. 这种新的方法提高了复杂的医疗保健系统的财务风险管理.
科学领域:
- 医疗保健中的人工智能
- 医疗信息学 医疗信息学
- 计算经济学 计算经济学
背景情况:
- 在医疗保健中有效的财务风险管理需要平衡治疗质量和成本效益.
- 智能决策对于优化医疗保健系统的资源配置至关重要.
- 当前的方法往往难以将财务优化与临床有效性相结合.
研究的目的:
- 提出一种新的混合框架,将强化学习 (RL) 与知识图增强的神经网络相结合.
- 优化医疗保健计费决策,同时保持诊断准确度.
- 加强医疗保健系统的财务风险管理和成本效益.
主要方法:
- 使用结构化特征,深度潜伏表示和知识图语义嵌入编码的患者个人资料.
- 使用深度Q网络 (DQN) 或近接政策优化 (PPO) 进行训练的强化学习代理.
- 混合框架将数据驱动的学习与结构化的医疗知识相结合,以实现情境意识的决策.
主要成果:
- 拟议的模型显著优于传统的回归器,深度神经网络和独立的RL代理.
- 在成本预测错误,诊断分类准确性和累积奖励方面取得了明显的改进.
- 在保持临床有效性的同时,实现了显著的平均计费减少.
结论:
- 将数据驱动学习与结构化医学知识相结合,对于医疗保健决策有价值.
- 混合框架使复杂的医疗保健环境中能够实现环境意识和成本效益的财务管理.
- 这种方法为优化计费策略和提高医疗保健系统整体效率提供了一个有希望的解决方案.
相关概念视频
01:30Health Information Technology and Healthcare Information System
917
Health Information Technology (HIT)
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
917
01:29Issues And Trends In Healthcare Delivery System
5.8K
The issues and trends in healthcare delivery are constantly changing. The COVID-19 pandemic is one recent issue that wreaked havoc on healthcare systems, causing a shortage of healthcare workers, high demand for medicines and supplies, and increased medical expenditure due to a lack of insurance. Other issues include rising healthcare costs and care fragmentation.
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
5.8K
01:20Integrated Healthcare System
1.8K
An integrated healthcare system (IHS) is a set of organizations that provides for or arranges to provide coordinated and continuous service to a defined population. The IHS takes responsibility for that particular population's health status and outcome, both clinically and fiscally. An integrated healthcare system is a well-organized, well-coordinated, and collaborative network. The integrated delivery system is a network that connects different healthcare providers to deliver organized,...
1.8K
01:27Nursing Clinical Information System
865
Nursing Clinical Information System (NCIS)
A Nursing Clinical Information System (NCIS) is a specialized type of healthcare information system tailored to meet the unique needs of nursing practice. It incorporates the principles of nursing informatics to streamline information management and improve the quality of care delivery.
Critical attributes of NCIS include:
A Nursing Clinical Information System (NCIS) is a specialized type of healthcare information system tailored to meet the unique needs of nursing practice. It incorporates the principles of nursing informatics to streamline information management and improve the quality of care delivery.
Critical attributes of NCIS include:
865
01:26Methods Of Healthcare Delivery System
3.5K
At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
3.5K
01:11Secondary Healthcare System
1.6K
Secondary healthcare is offered by a specialist, generally in hospitals or clinics for patients referred by primary healthcare providers. It occurs when a person has an illness or injury that requires specific medical care. Secondary care is often referred to as acute care. Secondary care can range from uncomplicated care to repair a minor laceration or treat a strep throat infection to more complicated emergent care, such as treating a head injury sustained in an automobile accident. Whatever...
1.6K