Language Model Classifier Aligns Better with Physician Word Sensitivity than XGBoost on Readmission Prediction

Traditional evaluation metrics for classification in natural language processing such as accuracy and area under the curve fail to differentiate between models with different predictive behaviors despite their similar performance metrics. We introduce sensitivity score, a metric that scrutinizes models' behaviors at the vocabulary level to provide insights into disparities in their decision-making logic. We assess the sensitivity score on a set of representative words in the test set using two classifiers trained for hospital readmission classification with similar performance statistics. Our experiments compare the decision-making logic of clinicians and classifiers based on rank correlations of sensitivity scores. The results indicate that the language model's sensitivity score aligns better with the professionals than the xgboost classifier on tf-idf embeddings, which suggests that xgboost uses some spurious features. Overall, this metric offers a novel perspective on assessing models' robustness by quantifying their discrepancy with professional opinions. Our code is available on GitHub (https://github.com/nyuolab/Model_Sensitivity).

Predictive Modeling in the Presence of Nuisance-Induced Spurious Correlations

Deep predictive models often make use of spurious correlations between the label and the covariates that differ between training and test distributions. In many classification tasks, spurious correlations are induced by a changing relationship between the label and some nuisance variables correlated with the covariates. For example, in classifying animals in natural images, the background, which is the nuisance, can predict the type of animal. This nuisance-label relationship does not always hold. We formalize a family of distributions that only differ in the nuisance-label relationship and introduce a distribution where this relationship is broken called the nuisance-randomized distribution. We introduce a set of predictive models built from the nuisance-randomized distribution with representations, that when conditioned on, do not correlate the label and the nuisance. For models in this set, we lower bound the performance for any member of the family with the mutual information between the representation and the label under the nuisance-randomized distribution. To build predictive models that maximize the performance lower bound, we develop Nuisance-Randomized Distillation (NURD). We evaluate NURD on a synthetic example, colored-MNIST, and classifying chest X-rays. When using non-lung patches as the nuisance in classifying chest X-rays, NURD produces models that predict pneumonia under strong spurious correlations.

Confounding variables can degrade generalization performance of radiological deep learning models

Early results in using convolutional neural networks (CNNs) on x-rays to diagnose disease have been promising, but it has not yet been shown that models trained on x-rays from one hospital or one group of hospitals will work equally well at different hospitals. Before these tools are used for computer-aided diagnosis in real-world clinical settings, we must verify their ability to generalize across a variety of hospital systems. A cross-sectional design was used to train and evaluate pneumonia screening CNNs on 158,323 chest x-rays from NIH (n=112,120 from 30,805 patients), Mount Sinai (42,396 from 12,904 patients), and Indiana (n=3,807 from 3,683 patients). In 3 / 5 natural comparisons, performance on chest x-rays from outside hospitals was significantly lower than on held-out x-rays from the original hospital systems. CNNs were able to detect where an x-ray was acquired (hospital system, hospital department) with extremely high accuracy and calibrate predictions accordingly. The performance of CNNs in diagnosing diseases on x-rays may reflect not only their ability to identify disease-specific imaging findings on x-rays, but also their ability to exploit confounding information. Estimates of CNN performance based on test data from hospital systems used for model training may overstate their likely real-world performance.