Bayesian mixed-effect higher-order hidden Markov models with applications to predictive healthcare using electronic health records
提出一种贝叶斯混合效应高阶隐马尔可夫模型，用于捕捉电子健康记录中患者疾病进展的复杂动态和个体差异，并开发分类器预测重症监护患者的急性低血压发作。
The disease progression dynamics observed in electronic health records often reflect patients’ health condition evolution, holding the promise of enabling the development of clinical predictive models. These dynamics, however, generally display significant variability among patients, due to some critical factors (e.g., gender and age) and patient-level heterogeneity. Moreover, future health state may not only depend on the current state, but also more distant history states due to the complicated disease progression. To capture this complex transition behavior and address mixed effects in clinical prediction problems, we propose a novel and flexible Bayesian Mixed-Effect Higher-Order Hidden Markov Model (MHOHMM), and develop a classifier based on MHOHMMs. A range of MHOHMMs are designed to capture different data structures and the optimal one is identified by using the k-fold cross-validation approach. An effective two-stage Markov chain Monte Carlo (MCMC) sampling algorithm is designed for model inference. A simulation study is conducted to evaluate the performance of the proposed sampling algorithm and the MHOHMM-based classification method. The practical utility of the proposed framework is demonstrated by a case study on the acute hypotensive episode prediction for intensive care unit patients. Our results show that the MHOHMM-based framework provides good prediction performance.