Stabilizing sparse Cox model using clinical structures in electronic medical records

Stability in clinical prediction models is crucial for transferability between studies, yet has received little attention. The problem is paramount in highdimensional data which invites sparse models with feature selection capability. We introduce an effective method to stabilize sparse Cox model of time-to-events using clinical structures inherent in Electronic Medical Records (EMR). Model estimation is stabilized using a feature graph derived from two types of EMR structures: temporal structure of disease and intervention recurrences, and hierarchical structure of medical knowledge and practices. We demonstrate the efficacy of the method in predicting time-to-readmission of heart failure patients. On two stability measures – the Jaccard index and the Consistency index – the use of clinical structures significantly increased feature stability without hurting discriminative power. Our model reported a competitive AUC of 0.64 (95% CIs: [0.58,0.69]) for 6 months prediction.