The health outcomes of high-need patients can be substantially influenced by the degree of patient engagement in their own care. The role of care managers includes that of enrolling patients into care programs and keeping them sufficiently engaged in the program, so that patients can attain various goals. The attainment of these goals is expected to improve the patients' health outcomes. In this paper, we present a real world data-driven method and the behavioral engagement scoring pipeline for scoring the engagement level of a patient in two regards: (1) Their interest in enrolling into a relevant care program, and (2) their interest and commitment to program goals. We use this score to predict a patient's propensity to respond (i.e., to a call for enrollment into a program, or to an assigned program goal). Using real-world care management data, we show that our scoring method successfully predicts patient engagement. We also show that we are able to provide interpretable insights to care managers, using prototypical patients as a point of reference, without sacrificing prediction performance.
To further differentiate engagement strategies from CMDS data, in this paper we particularly focus on methods that account for case-based reasoning to improve the interpretability of clustering models, e.g., selecting prototypical cases to represent the learned clusters @cite_29 . In particular, we incorporate locally supervised metric learning @cite_19 and prototypical case-based reasoning in a machine learning model to identify explainable engagement behavioral profiles and to produce personalized engagement scores.
@cite_19 @cite_29
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Effective patient similarity assessment is important for clinical decision support. It enables the capture of past experience as manifested in the collective longitudinal medical records of patients to help clinicians assess the likely outcomes resulting from their decisions and actions. However, it is challenging to devise a patient similarity metric that is clinically relevant and semantically sound. Patient similarity is highly context sensitive: it depends on factors such as the disease, the particular stage of the disease, and co-morbidities. One way to discern the semantics in a particular context is to take advantage of physicians’ expert knowledge as reflected in labels assigned to some patients. In this paper we present a method that leverages localized supervised metric learning to effectively incorporate such expert knowledge to arrive at semantically sound patient similarity measures. Experiments using data obtained from the MIMIC II database demonstrate the effectiveness of this approach. We present the Bayesian Case Model (BCM), a general framework for Bayesian case-based reasoning (CBR) and prototype classification and clustering. BCM brings the intuitive power of CBR to a Bayesian generative framework. The BCM learns prototypes, the "quintessential" observations that best represent clusters in a dataset, by performing joint inference on cluster labels, prototypes and important features. Simultaneously, BCM pursues sparsity by learning subspaces, the sets of features that play important roles in the characterization of the prototypes. The prototype and subspace representation provides quantitative benefits in interpretability while preserving classification accuracy. Human subject experiments verify statistically significant improvements to participants' understanding when using explanations produced by BCM, compared to those given by prior art.