Handling Missing Data in Clinical Decision Support
Handling Missing Data in Clinical Decision Support
David
David
 
Sánchez-Pinsach
Sánchez-Pinsach
 (
18/Dec/2020
18/Dec/2020
)
Handling Missing Data in Clinical Decision Support
Handling Missing Data in Clinical Decision Support
 

An industrial PhD

Advisors: 

Josep Lluís Arcos

Josep Lluís Arcos

University: 

Abstract: 

Deciding which are the best treatments is a complex task when patients suffer multiple impairments and when a multidisciplinary team is involved in the intervention. There is always more than a unique treatment option and the results sometimes can be viewed in a short period or only be capable to be measured when the treatment is finished. In this context, the design of effective Clinical Decision Support Systems (CDSS) to help clinicians to select most appropriate interventions is still a challenge.
The amount of available data is not always the same for all patients, especially in early treatment stages, hindering the inference in CDSS. To improve the capabilities of CDSS, different components are proposed within a CDSS framework for long-term treatments. A first component is focused on improving the quality of the inferences in missing data scenarios. The Dynamic Multiple Imputation (DMI) algorithm is presented as an effective methodology for data enhancement in CDSS. DMI is capable to adapt to different scenarios with a low or high percentage of missing data. Several experiments conducted reveal that DMI is competitive with regression problems. A second component is devoted to weigh confidence measures, given the uncertainty associated to missing information, by incorporating Mutual Information measures in confidence existing estimators. A third component, based on a community detection algorithm, is proposed to find relationships between clinical decisions that are not explicit. Finally, to illustrate the applicability of different proposed components, two real clinical use cases with chronic patients are presented. The first in the hospital context and the other in the home context.

Deciding which are the best treatments is a complex task when patients suffer multiple impairments and when a multidisciplinary team is involved in the intervention. There is always more than a unique treatment option and the results sometimes can be viewed in a short period or only be capable to be measured when the treatment is finished. In this context, the design of effective Clinical Decision Support Systems (CDSS) to help clinicians to select most appropriate interventions is still a challenge.
The amount of available data is not always the same for all patients, especially in early treatment stages, hindering the inference in CDSS. To improve the capabilities of CDSS, different components are proposed within a CDSS framework for long-term treatments. A first component is focused on improving the quality of the inferences in missing data scenarios. The Dynamic Multiple Imputation (DMI) algorithm is presented as an effective methodology for data enhancement in CDSS. DMI is capable to adapt to different scenarios with a low or high percentage of missing data. Several experiments conducted reveal that DMI is competitive with regression problems. A second component is devoted to weigh confidence measures, given the uncertainty associated to missing information, by incorporating Mutual Information measures in confidence existing estimators. A third component, based on a community detection algorithm, is proposed to find relationships between clinical decisions that are not explicit. Finally, to illustrate the applicability of different proposed components, two real clinical use cases with chronic patients are presented. The first in the hospital context and the other in the home context.