Enhanced Metadata Design, Architecture, and Learning (MeDAL) for Development of Generalizable Deep Learning-based Predictive Analytics from Electronic Health Records

增强元数据设计、架构和学习 (MeDAL)，用于根据电子健康记录开发基于深度学习的通用预测分析

• 批准号: 10265157
• 负责人: SHAMIM NEMATI
• 金额: $ 39.4万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-25 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10265157
• 关键词: Accident and Emergency department; Acute Renal Failure with Renal Papillary Necrosis; Adverse event; Algorithms; Antibiotics; Architecture; Area Under Curve; Artificial Intelligence; Biometry; Calibration; Caring; Cessation of life; Code; Collaborations; Collection; Computer software; Computers; Confidence Intervals; Critical Illness; Data; Data Element; Data Provenance; Data Set; Data Sources; Development; Devices; Effectiveness; Electronic Health Record; Ensure; Environment; Evaluation; Event; Expenditure; Fast Healthcare Interoperability Resources; Frequencies; Funding; General Hospitals; Goals; Health; Health Expenditures; Heterogeneity; Hospital Costs; Hospital Mortality; Hospitalization; Hospitals; Hour; Incidence; Individual; Infection; Inflammation; Institution; Intensive Care Units; Learning; Length of Stay; Life; Measurement; Measures; Medical; Metadata; Methodology; Methods; Modeling; Morbidity - disease rate; Organ failure; Outcome; Patient-Focused Outcomes; Patients; Pattern; Performance; Pharmaceutical Preparations; Pilot Projects; Population; Predictive Analytics; Prevention; Process; Reproducibility; Research; Research Personnel; Risk; Risk Assessment; Risk Estimate; Savings; Sepsis; Septic Shock; Site; Source; Standardization; Testing; Time; Training; Uncertainty; Variant; Work; acute care; aging population; authority; base; cloud based; deep learning; demographics; design; improved; interest; novel; patient population; patient response; personalized care; portability; prediction algorithm; predictive modeling; pressure; prevent; prospective; research and development; response; septic patients; theories; tool; treatment optimization; ward

Sepsis, Septic Shock, and Acute Kidney Injury (AKI) are among the top causes of hospital mortality, morbidity, and an increase in duration and cost of hospitalization. Successful prevention and management of these conditions rely on the ability of clinicians to estimate the risk, and ideally, to anticipate and prevent these events. Acute care settings and in particular intensive care units (ICUs) provide an environment where an immense amount of data is acquired, and it is expected that with the advent of wearables and biometric patches even more data will be available in such settings. But at present, very little of these data are used effectively to prognosticate, and the existing predictive analytics risk scores suffer from lack of generalizability across institutions and performance degradation within the same institution over time. The PIs on this proposal recently demonstrated that a Deep Learning-based algorithm can reliably predict new sepsis cases in the emergency departments, general hospital wards, and ICUs by as much as 4-6 hours in advance and an area under the curve (ROC) of 0.85-0.90. Furthermore, through a 2-year pilot study funded via Biomedical Advanced Research and Development Authority (BARDA), we recently joined forces in a multicenter academic consortium to retrospectively validate this algorithm at each site. Our collaboration has resulted in a multi-center longitudinal EHR dataset of critically ill patients and has generated several important questions and findings related to design of portable and generalizable predictive analytics algorithms that are robust to problems arising from gaps, errors, and biases in electronic health records (EHRs) due to workflow-related factors (e.g. staffing-level), and heterogeneity of patient populations and measurement devices. We propose to continue our prior work by designing new deep learning architectures that are more robust to data missingness and biases introduced through the variability in process of care, 2) development of new learning methodologies to improve generalizability of the proposed models under data/population drifts (aka distributional changes), 3) enhanced metadata design to assist in quantifying ‘conditions for use’ of such algorithms via algorithmic controls, and 4) HL7 and FHIR-based prospective implementation and testing of these methodologies to provide real-world evidence for the effectiveness of the proposed approaches. Ultimately, these novel methodologies and tools will enhance our ability to use EHR and other types of continuously measured longitudinal data to predict adverse events, assess patients’ response to therapy, and optimize and personalize care at the beside.

败血症、感染性休克和急性肾损伤（AKI）是医院死亡的主要原因，