Abstract
Medical protocols and guidelines can be looked upon as concurrent programs, where the patient’s state dynamically changes over time. Methods based on verification and model-checking developed in the past have been shown to offer insight into the correctness of guidelines and protocols by adopting a logical point of view. However, there is uncertainty involved both in the management of the disease and the way the disease will develop, and, therefore, a probabilistic view on medical protocols seems more appropriate. Representations using Bayesian networks capture that uncertainty, but usually concern a single patient group and do not capture the dynamic nature of care. In this paper, we propose a new method inspired by automata learning to represent and identify patient groups for obtaining insight into the care that patients have received. We evaluate this approach using data obtained from general practitioners and identify significant differences in patients who were diagnosed with a transient ischemic attack. Finally, we discuss the implications of such a computational method for the analysis of medical protocols and guidelines.
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ten Teije, A., Marcos, M., Balser, M., van Croonenborgd, J., Duellic, C., van Harmelena, F., Lucas, P., Miksch, S., Reif, W., Rosenbrand, K., Seyfang, A.: Improving medical protocols by formal methods. Artificial Intelligence in Medicine 63(3), 193–209 (2006)
Hommersom, A., Groot, P., Lucas, P., Balser, M., Schmitt, J.: Verification of medical guidelines using background knowledge in task networks. IEEE Transactions on Knowledge and Data Engineering 19(6), 832–846 (2007)
Bottrighi, A., Giordano, L., Molino, G., Montani, S., Terenziani, P., Torchio, M.: Adopting model checking techniques for clinical guidelines verification. Artificial Intelligence in Medicine 48(1), 1–19 (2010)
Quaglini, S.: Compliance with clinical practice guidelines. In: Teije, A.T., Miksch, S., Lucas, P. (eds.) Computer-Based Medical Guidelines and Protocols: A Primer and Current Trends. Studies in Health Technology and Informatics, vol. 139, pp. 160–179. IOS Press (2008)
Field, M., Lohr, K. (eds.): Clinical Practice Guidelines: Directions for a New Program. National Academy Press, Institute of Medicine, Washington, D.C (1990)
ten Teije, A., Miksch, S., Lucas, P. (eds.): Computer-based Clinical Guidelines and Protocols: a Primer and Current Trends. IOS Press, Amsterdam (2008)
Fox, J., Das, S.: Safe and Sound: Artificial Intelligence in Hazardous Applications. AAAI Press (2000)
Peleg, M., Boxwala, A., Ogunyemi, O., Zeng, P., Tu, S., Lacson, R., Begnstam, E., Ash, N.: GLIF3: The evolution of a guideline representation format. In: Proc. AMIA Annual Symposium, pp. 645–649 (2000)
Fox, J., Johns, N., Rahmanzadeh, A., Thomson, R.: PROforma: a general technology for clinical decision support systems. Computer Methods and Programs in Biomedicine 54, 59–67 (1997)
Shahar, Y., Miksch, S., Johnson, P.: The Asgaard project: A task-specific framework for the application and critiquing of time-orientied clinical guidelines. Artificial Intelligence in Medicine 14, 29–51 (1998)
Tu, S., Musen, M.: From guideline modeling to guideline execution: Defining guideline based decision-support services. In: Proceedings of American Medical Informatics Association Symposium, Los Angeles, CA, pp. 863–867 (1999)
Hommersom, A., Groot, P., Lucas, P., Balser, M., Schmitt, J.: Verification of medical guidelines using background knowledge in task networks. IEEE Transactions on Knowledge and Data Engineering 19(6), 832–846 (2007)
Pearl, J.: Probabilistic Reasoning in Intelligent Systems: Networks of Plausible Inference. Morgan Kaufmann, San Francisco (1988)
Andreassen, S.: Planning of therapy and tests in causal probabilistic networks. Artificial Intelligence in Medicine 4(3), 227–241 (1992)
Lucas, P., van der Gaag, L., Abu-Hanna, A.: Bayesian networks in biomedicine and health-care. Artificial Intelligence in Medicine 30, 201–214 (2004)
Dagum, P., Galper, A., Horvitz, E.: Dynamic network models for forecasting. In: Proceedings of UAI 1992, pp. 41–48 (1992)
Neapolitan, R.: Learning Bayesian Networks. Pearson (2004)
Robinson, R.: Counting unlabeled acyclic graphs. In: LNM, vol. 622, pp. 220–227. Springer, NY (1977)
Gillespie, S.B., Perlman, M.D.: Enumerating Markov Equivalence Classes of Acyclic Digraph Models. In: UAI 2001 (2001)
Ghahramani, Z.: Learning dynamic bayesian networks. In: Giles, C.L., Gori, M. (eds.) IIASS-EMFCSC-School 1997. LNCS (LNAI), vol. 1387, pp. 168–197. Springer, Heidelberg (1998)
Cook, J.E., Wolf, A.L.: Discovering models of software processes from event-based data. ACM Trans. Softw. Eng. Methodol. 7, 215–249 (1998)
Lee, D., Yannakakis, M.: Principles and methods of testing finite state machines - a survey. Proceedings of the IEEE 84, 1090–1123 (1996)
Bertolino, A., Inverardi, P., Pelliccione, P., Tivoli, M.: Automatic synthesis of behavior protocols for composable web-services. In: Proceedings of the Joint Meeting of the European Software Engineering Conference and the ACM SIGSOFT Symposium on the Foundations of Software Engineering, pp. 141–150. ACM (2009)
Aarts, F., Schmaltz, J., Vaandrager, F.: Inference and abstraction of the biometric passport. In: Margaria, T., Steffen, B. (eds.) ISoLA 2010, Part I. LNCS, vol. 6415, pp. 673–686. Springer, Heidelberg (2010)
Walkinshaw, N., Bogdanov, K., Holcombe, M., Salahuddin, S.: Reverse engineering state machines by interactive grammar inference. In: Proceedings of the 14th Working Conference on Reverse Engineering, pp. 209–218. IEEE (2007)
de la Higuera, C.: Grammatical Inference: Learning Automata and Grammars. Cambridge University Press, New York (2010)
Sudkamp, T.A.: Languages and Machines: an introduction to the theory of computer science, 3rd edn. Addison-Wesley (2006)
Dupont, P., Denis, F., Esposito, Y.: Links between probabilistic automata and hidden Markov models: probability distributions, learning models and induction algorithms. Pattern Recognition 38, 1349–1371 (2005)
Boutilier, C., Dearden, R., Goldszmidt, M.: Exploiting structure in policy construction. In: IJCAI. AAAI (1995)
Geiger, D., Heckerman, D.: Knowledge representation and inference in similarity networks and Bayesian multinets. Artificial Intelligence 82, 45–74 (1996)
Visscher, S., Lucas, P.J.F., Flesch, I., Schurink, K.: Using temporal context-specific independence information in the exploratory analysis of disease processes. In: Bellazzi, R., Abu-Hanna, A., Hunter, J. (eds.) AIME 2007. LNCS (LNAI), vol. 4594, pp. 87–96. Springer, Heidelberg (2007)
Gutierrez, J., Ramirez, G., Rundek, T., Sacco, R.L.: Statin therapy in the prevention of recurrent cardiovascular events: a sex-based meta-analysis. Arch. Intern. Med. 172(12), 909–919 (2012)
Duivesteijn, W., Knobbe, A., Feelders, A., van Leeuwen, M.: Subgroup discovery meets bayesian networks – an exceptional model mining approach. In: Proceedings of the 2010 IEEE International Conference on Data Mining, ICDM 2010, pp. 158–167. IEEE Computer Society, Washington, DC (2010)
Bohada, J.A., Riaño, D., LĂ³pez-VallverdĂº, J.A.: Automatic generation of clinical algorithms within the state-decision-action model. Expert Systems with Applications 39(12), 10709–10721 (2012)
LĂ³pez-VallverdĂº, J.A., Riaño, D., Bohada, J.A.: Improving medical decision trees by combining relevant health-care criteria. Expert Systems with Applications 39(14), 11782–11791 (2012)
Van der Aalst, W., Weijters, T., Maruster, L.: Workflow mining: Discovering process models from event logs. IEEE Transactions on Knowledge and Data Engineering 16(9), 1128–1142 (2004)
Mans, R.S., van der Aalst, W.M.P., Vanwersch, R.J.B., Moleman, A.J.: Process mining in healthcare data challenges when answering frequently posed questions. In: Lenz, R., Miksch, S., Peleg, M., Reichert, M., Riaño, D., ten Teije, A. (eds.) ProHealth 2012 and KR4HC 2012. LNCS, vol. 7738, pp. 140–153. Springer, Heidelberg (2013)
Kaymak, U., Mans, R., van de Steeg, T., Dierks, M.: On process mining in health care. In: SMC, pp. 1859–1864 (2012)
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Hommersom, A., Verwer, S., Lucas, P.J.F. (2013). Discovering Probabilistic Structures of Healthcare Processes. In: Riaño, D., Lenz, R., Miksch, S., Peleg, M., Reichert, M., ten Teije, A. (eds) Process Support and Knowledge Representation in Health Care. ProHealth KR4HC 2013 2013. Lecture Notes in Computer Science(), vol 8268. Springer, Cham. https://doi.org/10.1007/978-3-319-03916-9_5
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DOI: https://doi.org/10.1007/978-3-319-03916-9_5
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