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arXiv 2601.03475cs.AI
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CPGPrompt:将临床指南转化为LLM可执行的决策支持

CPGPrompt: Translating Clinical Guidelines into LLM-Executable Decision Support

Information Science (Health Tech), Cornell Tech, New York, NY, USA(信息科学(健康科技),康奈尔科技,纽约,纽约州);Systems Engineering, Cornell University, Ithaca, NY, USA(系统工程,康奈尔大学,伊萨卡,纽约州);Population Health Sciences, Weill Cornell Medicine, New York, NY, USA(人口健康科学,韦尔医学院,纽约,纽约州);Computer and Information Science, Cornell University, Ithaca, NY, USA(计算机与信息科学,康奈尔大学,伊萨卡,纽约州);Department of Biomedical Informatics, Columbia University, New York, NY, USA(生物医学信息学系,哥伦比亚大学,纽约,纽约州);Department of Medicine, Weill Cornell Medicine, New York, NY, USA(医学系,韦尔医学院,纽约,纽约州);Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, USA(健康信息管理系,匹兹堡大学,匹兹堡,宾夕法尼亚州);Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA(临床与转化科学研究所,匹兹堡大学,匹兹堡,宾夕法尼亚州);Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA(神经病学系,德克萨斯西南医学中心,达拉斯,德克萨斯州);Peter O’Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA(彼得·奥·donnell Jr.脑研究所,德克萨斯西南医学中心,达拉斯,德克萨斯州);Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, USA(临床信息学中心,德克萨斯西南医学中心,达拉斯,美国);Institute of Artificial Intelligence for Digital Health, Weill Cornell Medicine, New York, NY USA(数字健康人工智能研究所,韦尔医学院,纽约,纽约州)

Ruiqi Deng, Geoffrey Martin, Tony Wang, Gongbo Zhang, Yi Liu, Chunhua Weng, Yanshan Wang, Justin F Rousseau, Yifan Peng

AI总结:

CPGPrompt通过将临床指南转化为LLM可执行的结构化决策树,实现对患者病例的高效评估,提升了专科转诊和路径分类的准确性。

摘要:

临床实践指南(CPGs)为患者护理提供基于证据的建议;然而,将其整合到人工智能(AI)中仍然具有挑战性。以往的方法,如基于规则的系统,存在显著局限性,包括可解释性差、对指南的遵守不一致以及应用领域狭窄。为此,我们开发并验证了CPGPrompt,一个自动提示系统,将叙述性临床指南转化为大型语言模型(LLMs)。我们的框架将CPGs转换为结构化的决策树,并利用LLM动态导航这些树以评估患者病例。在三个领域(头痛、下背痛和前列腺癌)生成合成案例,并将其分配到四个类别中以测试不同的决策场景。系统性能在二元专科转诊决策和细粒度路径分类任务上进行了评估。二元专科转诊分类在所有领域均表现出一致的强劲表现(F1:0.85-1.00),召回率(1.00 ± 0.00)高。相比之下,多类路径分配显示出较低的表现,存在领域特定的差异:头痛(F1:0.47)、下背痛(F1:0.72)和前列腺癌(F1:0.77)。领域特定的表现差异反映了每个指南的结构。头痛指南突显了否定处理的挑战。下背痛指南需要时间推理。相比之下,前列腺癌路径受益于可量化的实验室测试,导致更可靠的决策。

英文摘要:

Clinical practice guidelines (CPGs) provide evidence-based recommendations for patient care; however, integrating them into Artificial Intelligence (AI) remains challenging. Previous approaches, such as rule-based systems, face significant limitations, including poor interpretability, inconsistent adherence to guidelines, and narrow domain applicability. To address this, we develop and validate CPGPrompt, an auto-prompting system that converts narrative clinical guidelines into large language models (LLMs). Our framework translates CPGs into structured decision trees and utilizes an LLM to dynamically navigate them for patient case evaluation. Synthetic vignettes were generated across three domains (headache, lower back pain, and prostate cancer) and distributed into four categories to test different decision scenarios. System performance was assessed on both binary specialty-referral decisions and fine-grained pathway-classification tasks. The binary specialty referral classification achieved consistently strong performance across all domains (F1: 0.85-1.00), with high recall (1.00 $\pm$ 0.00). In contrast, multi-class pathway assignment showed reduced performance, with domain-specific variations: headache (F1: 0.47), lower back pain (F1: 0.72), and prostate cancer (F1: 0.77). Domain-specific performance differences reflected the structure of each guideline. The headache guideline highlighted challenges with negation handling. The lower back pain guideline required temporal reasoning. In contrast, prostate cancer pathways benefited from quantifiable laboratory tests, resulting in more reliable decision-making.

机构、总结、中文摘要均由AI分析而来,可能存在错误,请以论文正文为准。

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