Consensus Modeling - A Transfer Learning Approach for Small Health Systems.

The adoption of predictive modeling for clinical decision support is accelerating in healthcare, however, the need for large sample sizes puts smaller health systems at a disadvantage. Small health systems have insufficient positive cases to build models are left with three choices. First, they can obtain already trained models, which are often too generic. Second, they can participate in research networks, building a model through a network-wide data set. Since small hospitals can only contribute small amounts of data influencing the resulting shared model minimally, this approach yields only minimal specialization. The third option is transfer learning, where a model previously trained on a large population is refined to the specific population, which carries the danger of over-specializing to the idiosyncrasies of the small data set. In this paper, we present a novel paradigm, consensus modeling, that allows a small health system to collaborate with a larger system to build a model specific to the smaller system without sharing any data instances. The method is similar to transfer learning in that it refines models from the larger system to be specific to the small system, but through iterative refinement, the larger system alleviates the risk of over-specializing to the small system. We evaluated the approach on predicting postoperative complications at two health systems with 9,044 and 38,545 patients. The model obtained from the proposed consensus modeling paradigm achieved a predictive performance on the small system that is as good as the transfer learning approach (AUC 0.71 vs 0.71) but significantly outperformed the transfer learning approach on the large dataset (AUC 0.80 vs 0.65) suggesting significantly reduced over-specializing.