A Roadmap for Boosting Model Generalizability for Predicting Hospital Encounters for Asthma
Bibliographic record
Abstract
In the United States, ~9% of people have asthma. Each year, asthma incurs high health care cost and many hospital encounters covering 1.8 million emergency room visits and 439,000 hospitalizations. A small percentage of patients with asthma use most health care resources. To improve outcomes and cut resource use, many health care systems use predictive models to prospectively find high-risk patients and enroll them in care management for preventive care. For maximal benefit from costly care management with limited service capacity, only patients at the highest risk should be enrolled. However, prior models built by others miss >50% of true highest-risk patients and mislabel many low-risk patients as high risk, leading to suboptimal care and wasted resources. To address this issue, 3 site-specific models were recently built to predict hospital encounters for asthma, gaining up to >11% better performance. However, these models do not generalize well across sites and patient subgroups, creating 2 gaps before translating these models into clinical use. This paper points out these 2 gaps and outlines 2 corresponding solutions: (1) a new machine learning technique to create cross-site generalizable predictive models to accurately find high-risk patients and (2) a new machine learning technique to automatically raise model performance for poorly performing subgroups while maintaining model performance on other subgroups. This gives a roadmap for future research.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.025 | 0.053 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.002 | 0.007 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".