论文标题
估计患者轨迹的平均因果影响
Estimating average causal effects from patient trajectories
论文作者
论文摘要
在医学实践中,根据对患者结局的预期因果影响选择治疗。在这里,估计因果效应的黄金标准是随机对照试验。但是,这样的试验是昂贵的,有时甚至是不道德的。取而代之的是,医学实践越来越有兴趣从电子健康记录(即观察数据)中估算患者(子)组之间的因果影响。在本文中,我们旨在估算随着时间时间收集的观察数据(患者轨迹)的平均因果效应(ACE)。为此,我们提出了Deepace:端到端的深度学习模型。 DeepAce利用迭代的G型公式来调整随时间变化的混杂因素引起的偏差。此外,我们开发了一种新颖的顺序靶向程序,该程序可确保深层具有有利的理论特性,即具有双重稳健性和渐近性。据我们所知,这是第一项提出的端到端深度学习模型,该模型量身定制,用于估计时变量。我们比较了大量实验中的Deepace,证实了它可以实现最新的性能。我们进一步为患有腰痛的患者提供了一个案例研究,以证明DeepAce为临床实践产生了重要而有意义的发现。我们的工作使从业人员能够根据人口影响制定有效的治疗建议。
In medical practice, treatments are selected based on the expected causal effects on patient outcomes. Here, the gold standard for estimating causal effects are randomized controlled trials; however, such trials are costly and sometimes even unethical. Instead, medical practice is increasingly interested in estimating causal effects among patient (sub)groups from electronic health records, that is, observational data. In this paper, we aim at estimating the average causal effect (ACE) from observational data (patient trajectories) that are collected over time. For this, we propose DeepACE: an end-to-end deep learning model. DeepACE leverages the iterative G-computation formula to adjust for the bias induced by time-varying confounders. Moreover, we develop a novel sequential targeting procedure which ensures that DeepACE has favorable theoretical properties, i.e., is doubly robust and asymptotically efficient. To the best of our knowledge, this is the first work that proposes an end-to-end deep learning model tailored for estimating time-varying ACEs. We compare DeepACE in an extensive number of experiments, confirming that it achieves state-of-the-art performance. We further provide a case study for patients suffering from low back pain to demonstrate that DeepACE generates important and meaningful findings for clinical practice. Our work enables practitioners to develop effective treatment recommendations based on population effects.