Yubo Li

Yubo Li, Saba Al-Sayouri, Rema Padman

This study explores the potential of utilizing administrative claims data, combined with advanced machine learning and deep learning techniques, to predict the progression of Chronic Kidney Disease (CKD) to End-Stage Renal Disease (ESRD). We analyze a comprehensive, 10-year dataset provided by a major health insurance organization to develop prediction models for multiple observation windows using traditional machine learning methods such as Random Forest and XGBoost as well as deep learning approaches such as Long Short-Term Memory (LSTM) networks. Our findings demonstrate that the LSTM model, particularly with a 24-month observation window, exhibits superior performance in predicting ESRD progression, outperforming existing models in the literature. We further apply SHapley Additive exPlanations (SHAP) analysis to enhance interpretability, providing insights into the impact of individual features on predictions at the individual patient level. This study underscores the value of leveraging administrative claims data for CKD management and predicting ESRD progression.

Yubo Li, Xinyu Yao, Rema Padman

Despite the outstanding performance of deep learning models in clinical prediction tasks, explainability remains a significant challenge. Inspired by transformer architectures, we introduce the Temporal-Feature Cross Attention Mechanism (TFCAM), a novel deep learning framework designed to capture dynamic interactions among clinical features across time, enhancing both predictive accuracy and interpretability. In an experiment with 1,422 patients with Chronic Kidney Disease, predicting progression to End-Stage Renal Disease, TFCAM outperformed LSTM and RETAIN baselines, achieving an AUROC of 0.95 and an F1-score of 0.69. Beyond performance gains, TFCAM provides multi-level explainability by identifying critical temporal periods, ranking feature importance, and quantifying how features influence each other across time before affecting predictions. Our approach addresses the "black box" limitations of deep learning in healthcare, offering clinicians transparent insights into disease progression mechanisms while maintaining state-of-the-art predictive performance.

Yubo Li, Rema Padman

Modeling clinical time-series data is hampered by the challenge of capturing latent, time-varying dependencies among features. State-of-the-art approaches often rely on black-box mechanisms or simple aggregation, failing to explicitly model how the influence of one clinical variable propagates through others over time. We propose $\textbf{Chain-of-Influence (CoI)}$, an interpretable deep learning framework that constructs an explicit, time-unfolded graph of feature interactions. CoI leverages a multi-level attention architecture: first, a temporal attention layer identifies critical time points in a patient's record; second, a cross-feature attention layer models the directed influence from features at these time points to subsequent features. This design enables the tracing of influence pathways, providing a granular audit trail that shows how any feature at any time contributes to the final prediction, both directly and through its influence on other variables. We evaluate CoI on mortality and disease progression tasks using the MIMIC-IV dataset and a private chronic kidney disease cohort. Our framework significantly outperforms existing methods in predictive accuracy. More importantly, through case studies, we show that CoI can uncover clinically meaningful, patient-specific patterns of disease progression that are opaque to other models, offering unprecedented transparency into the temporal and cross-feature dependencies that inform clinical decision-making.

Yubo Li, Ramayya Krishnan, Rema Padman

Large Language Models (LLMs) have revolutionized conversational AI, yet their robustness in extended multi-turn dialogues remains poorly understood. Existing evaluation frameworks focus on static benchmarks and single-turn assessments, failing to capture the temporal dynamics of conversational degradation that characterize real-world interactions. In this work, we present the first comprehensive survival analysis of conversational AI robustness, analyzing 36,951 conversation turns across 9 state-of-the-art LLMs to model failure as a time-to-event process. Our survival modeling framework-employing Cox proportional hazards, Accelerated Failure Time, and Random Survival Forest approaches-reveals extraordinary temporal dynamics. We find that abrupt, prompt-to-prompt(P2P) semantic drift is catastrophic, dramatically increasing the hazard of conversational failure. In stark contrast, gradual, cumulative drift is highly protective, vastly reducing the failure hazard and enabling significantly longer dialogues. AFT models with interactions demonstrate superior performance, achieving excellent discrimination and exceptional calibration. These findings establish survival analysis as a powerful paradigm for evaluating LLM robustness, offer concrete insights for designing resilient conversational agents, and challenge prevailing assumptions about the necessity of semantic consistency in conversational AI Systems.