Learning Personalized Treatment Rules from Electronic Health Records Using Topic Modeling Feature Extraction To address substantial heterogeneity in patient response to treatment of chronic disorders and achieve the promise of precision medicine, individualized treatment rules (ITRs) are estimated to tailor treatments according to patientspecific characteristics. Randomized controlled trials (RCTs) provide gold standard data for learning ITRs not subject to confounding bias. However, RCTs are often conducted under stringent inclusionexclusion criteria, and participants in RCTs may not reflect the general patient population. Thus, ITRs learned from RCTs lack generalizability to the broader real world patient population. Real world databases such as electronic health records (EHRs) provide new resources as complements to RCTs to facilitate evidencebased research for personalized medicine. However, to ensure the validity of ITRs learned from EHRs, a number of challenges including confounding bias and selection bias must be addressed. In this work, we propose a matchingbased machine learning method to estimate optimal individualized treatment rules from EHRs using interpretable features extracted from EHR documentation of medications and ICD diagnoses codes. We use a latent Dirichlet allocation (LDA) model to extract latent topics and weights as features for learning ITRs. Our method achieves confounding reduction in observational studies through matching treated and untreated individuals and improves treatment optimization by augmenting feature space with clinically meaningful LDAbased features. We apply the method to EHR data collected at New York Presbyterian Hospital clinical data warehouse in studying optimal secondline treatment for type 2 diabetes (T2D) patients. We use cross validation to show that ITRs outperforms uniform treatment strategies (i.e., assigning same treatment to all individuals), and including topic modeling features leads to more reduction of posttreatment complications.

Predictive Multilevel Patient Representations from Electronic Health Records The advent of the Internet era has led to an explosive growth in the Electronic Health Records (EHR) in the past decades. The EHR data can be regarded as a collection of clinical events, including laboratory results, medication records, physiological indicators, etc, which can be used for clinical outcome prediction tasks to support constructions of intelligent health systems. Learning patient representation from these clinical events for the clinical outcome prediction is an important but challenging step. Most related studies transform EHR data of a patient into a sequence of clinical events in temporal order and then use sequential models to learn patient representations for outcome prediction. However, clinical event sequence contains thousands of event types and temporal dependencies. We further make an observation that clinical events occurring in a short period are not constrained by any temporal order but events in a long term are influenced by temporal dependencies. The multiscale temporal property makes it difficult for traditional sequential models to capture the shortterm cooccurrence and the longterm temporal dependencies in clinical event sequences. In response to the above challenges, this paper proposes a Multilevel Representation Model (MRM). MRM first uses a sparse attention mechanism to model the shortterm cooccurrence, then uses intervalbased event pooling to remove redundant information and reduce sequence length and finally predicts clinical outcomes through Long ShortTerm Memory (LSTM). Experiments on realworld datasets indicate that our proposed model largely improves the performance of clinical outcome prediction tasks using EHR data.