As hospitals move towards automating and integrating their computing systems, more fine-grained hospital operations data are becoming available. These data include hospital architectural drawings, logs of interactions between patients and healthcare professionals, prescription data, procedures data, and data on patient admission, discharge, and transfers. This has opened up many fascinating avenues for healthcare-related prediction tasks for improving patient care. However, in order to leverage off-the-shelf machine learning software for these tasks, one needs to learn structured representations of entities involved from heterogeneous, dynamic data streams. Here, we propose DECENT, an auto-encoding heterogeneous co-evolving dynamic neural network, for learning heterogeneous dynamic embeddings of patients, doctors, rooms, and medications from diverse data streams. These embeddings capture similarities among doctors, rooms, patients, and medications based on static attributes and dynamic interactions. DECENT enables several applications in healthcare prediction, such as predicting mortality risk and case severity of patients, adverse events (e.g., transfer back into an intensive care unit), and future healthcare-associated infections. The results of using the learned patient embeddings in predictive modeling show that DECENT has a gain of up to 48.1% on the mortality risk prediction task, 12.6% on the case severity prediction task, 6.4% on the medical intensive care unit transfer task, and 3.8% on the Clostridioides difficile (C.diff) Infection (CDI) prediction task over the state-of-the-art baselines. In addition, case studies on the learned doctor, medication, and room embeddings show that our approach learns meaningful and interpretable embeddings.

Healthcare associated infections (HAIs) impose a substantial burden, both on patients and on the healthcare system. Designing effective strategies by using interventions such as vaccination, isolation, cleaning, mobility modification, etc., to reduce HAI spread is an important computational challenge. Spectral approaches are quite useful for modeling and solving problems of reducing disease spread over contact networks, but they have not been used for disease-spread models and contact networks that are specific for HAIs. Our main contribution in this paper is to close this gap. We make 3 specific contributions. (i) We present the first epidemic threshold results on temporal bipartite networks, i.e., a time-varying sequence of bipartite people-location network, for the Susceptible-Infected-Susceptible (SIS) model. (ii) We leverage our epidemic threshold result to pose the HAI mitigation problem as minimizing the spectral radius of the system matrix, while removing few nodes or edges. We present a scalable combinatorial algorithm that provides approximation guarantees. (iii) Through extensive experiments on actual healthcare contact networks derived from operations data from the University of Iowa Hospitals and Clinics, Carilion Clinic, and several other healthcare facilities, we show that our algorithm consistently outperforms a number of baselines (random, degree, top-k, eigen centrality) both in terms of reducing the spectral radius of the system matrix and in terms of reducing infections.

This paper studies the problem of detecting asymptomatic cases in a temporal contact network in which multiple outbreaks have occurred. For many infections, asymptomatic cases present a major obstacle to obtaining a precise understanding of infection-spread. We show that the key to detecting asymptomatic cases well, is taking into account both individual risk as well as the likelihood of disease-flow along edges. Most related research has ignored the interplay between these dual aspects influencing disease-spread. We take both aspects into account by formulating the asymptomatic case detection problem as a Directed Prize-Collecting Steiner Tree (DIRECTED PCST) problem. We present an approximation-preserving reduction from this problem to the Directed Steiner Tree problem and use this reduction to obtain scalable algorithms for the DIRECTED PCST problem. Using these algorithms, we solve instances with more than 1.5M edges obtained from both synthetic and actual fine-grained hospital data. On synthetic data, we demonstrate that our detection methods significantly outperform various baselines (with a gain of $3.6 \times$). As an application of our methods, we use a measure of exposure to detected asymptomatic Clostridioides difficile (C. diff) infection (CDI) cases as an additional feature for the important task of predicting symptomatic CDI cases. In this application, our method outperforms all baselines, including those that don’t use asymptomatic CDI cases as a feature and those that use other methods for detecting asymptomatic CDI cases. We also demonstrate that the solutions returned by our approach are clinically meaningful by presenting a case study.

This paper presents a high-fidelity agent-based simulation of the spread of methicillin-resistant Staphylococcus aureus (MRSA), a serious hospital acquired infection, within the dialysis unit at the University of Iowa Hospitals and Clinics (UIHC). The simulation is based on ten days of fine-grained healthcare worker (HCW) movement and interaction data collected from a sensor mote instrumentation of the dialysis unit by our research group in the fall of 2013. The simulation layers a detailed model of MRSA pathogen transfer, die-off, shedding, and infection on top of agent interactions obtained from data. The specific question this paper focuses on is whether there are simple, inexpensive architectural or process changes one can make in the dialysis unit to reduce the spread of MRSA? We evaluate two architectural changes of the nurses' station: (i) splitting the central nurses' station into two smaller distinct nurses' stations, and (ii) doubling the surface area of the nursing station. The first architectural change is modeled as a graph partitioning problem on a HCW contact network obtained from our HCW movement data. Somewhat counter-intuitively, our results suggest that the first architectural modification and the resulting reduction in HCW-HCW contacts has little to no effect on the spread of MRSA and may in fact lead to an increase in MRSA infection counts in some cases. In contrast, the second modification leads to a substantial reduction - between 12% and 22% for simulations with different parameters - in the number of patients infected by MRSA. These results suggest that the dynamics of an environmentally mediated infection such as MRSA may be quite different from that of infections whose spread is not substantially affected by the environment (e.g., respiratory infections or influenza).