Simão Paredes

Francisco Valente, Jorge Henriques, Simão Paredes et al.

We intend to create a new risk assessment methodology that combines the best characteristics of both risk score and machine learning models. More specifically, we aim to develop a method that, besides having a good performance, offers a personalized model and outcome for each patient, presents high interpretability, and incorporates an estimation of the prediction reliability which is not usually available. By combining these features in the same approach we expect that it can boost the confidence of physicians to use such a tool in their daily activity. In order to achieve the mentioned goals, a three-step methodology was developed: several rules were created by dichotomizing risk factors; such rules were trained with a machine learning classifier to predict the acceptance degree of each rule (the probability that the rule is correct) for each patient; that information was combined and used to compute the risk of mortality and the reliability of such prediction. The methodology was applied to a dataset of patients admitted with any type of acute coronary syndromes (ACS), to assess the 30-days all-cause mortality risk. The performance was compared with state-of-the-art approaches: logistic regression (LR), artificial neural network (ANN), and clinical risk score model (Global Registry of Acute Coronary Events - GRACE). The proposed approach achieved testing results identical to the standard LR, but offers superior interpretability and personalization; it also significantly outperforms the GRACE risk model and the standard ANN model. The calibration curve also suggests a very good generalization ability of the obtained model as it approaches the ideal curve. Finally, the reliability estimation of individual predictions presented a great correlation with the misclassifications rate. Those properties may have a beneficial application in other clinical scenarios as well. [abridged]

Francisco Valente, Simão Paredes, Jorge Henriques

In this study, we present a novel clinical decision support system and discuss its interpretability-related properties. It combines a decision set of rules with a machine learning scheme to offer global and local interpretability. More specifically, machine learning is used to predict the likelihood of each of those rules to be correct for a particular patient, which may also contribute to better predictive performances. Moreover, the reliability analysis of individual predictions is also addressed, contributing to further personalized interpretability. The combination of these several elements may be crucial to obtain the clinical stakeholders' trust, leading to a better assessment of patients' conditions and improvement of the physicians' decision-making.

Francisco Valente, Jorge Henriques, Simão Paredes et al.

One of the key challenges when developing a predictive model is the capability to describe the domain knowledge and the cause-effect relationships in a simple way. Decision rules are a useful and important methodology in this context, justifying their application in several areas, particularly in clinical practice. Several machine-learning classifiers have exploited the advantageous properties of decision rules to build intelligent prediction models, namely decision trees and ensembles of trees (ETs). However, such methodologies usually suffer from a trade-off between interpretability and predictive performance. Some procedures consider a simplification of ETs, using heuristic approaches to select an optimal reduced set of decision rules. In this paper, we introduce a novel step to those methodologies. We create a new component to predict if a given rule will be correct or not for a particular patient, which introduces personalization into the procedure. Furthermore, the validation results using three public clinical datasets suggest that it also allows to increase the predictive performance of the selected set of rules, improving the mentioned trade-off.