Combating the Bucket Effect:Multi-Knowledge Alignment for Medication Recommendation Xiang Li a,, Haixu Ma a,, Guanyong Wu a, Shi Mu a, Chen Li a, and Shunpan Liang a,b, a School of Information Science and Engineering, Yanshan University, Qin Huangdao, 066004, China b Xinjiang College Of Science & Technology, Korla, 841000, ChinaA R T I C L E I N F OKeywords: Medication Recommendation Molecular Representation Learning A B S T R A C T Medication recommendation is crucial in healthcare, offering effective treatments based on patient's electronic health records (EHR). Previous studies show that integrating more medication-related knowledge improves medication representation accuracy. However, not all medications encompass multiple types of knowledge data simultaneously. For instance, some medications provide only textual descriptions without structured data. This imbalance in data availability limits the performance of existing models, a challenge we term the "bucket effect" in medication recommendation. To fill this gap, we introduce a cross-modal medication encoder capable of seamlessly aligning data from different modalities and propose a medication recommendation framework to integrate Multiple types of K nowledge, named MKMed. Then, we combine the multi-knowledge medication representations with patient records for recommendations. Extensive experiments on the MIMIC-III and MIMIC-IV datasets demonstrate that MKMed mitigates the "bucket effect" in data, and significantly outperforms state-of-the-art baselines in recommendation accuracy and safety.1. Introduction Given the increasing demand for healthcare resources, there is a growing emphasis on AI-based medical systems. Medication recommendations Shang, Xiao, Ma, Li and Sun (2019); Wu, Qiu, Jiang, Qi and Wu (2022); Li, Liang, Hou and Ma (2024a), as a key area, aim to integrate clinical knowledge with patient electronic health records (EHR), enhancing the accuracy, safety, and efficiency of clinical decision-making for patients. Existing methods can be divided into two categories. The first category focuses on exploring the complex relationships between multiple medical events, optimizing patient representation by constructing complex networksLe, Tran and Venkatesh (2018); Jin, Yang, Sun, Liu, Qu and Tong (2018); Zheng, Wang, Xu, Shen, Qin, Huai, Liu and Chen (2021). For example, RAREMed Zhao, Jing, Feng, Wu, Gao and He (2024) focuses on the connections between rare events and others.

To enhance therapeutic outcomes from a pharmacological perspective, we propose MiranDa, designed for medication recommendation, which is the first actionable model capable of providing the estimated length of stay in hospitals (ELOS) as counterfactual outcomes that guide clinical practice and model training. In detail, MiranDa emulates the educational trajectory of doctors through two gradient-scaling phases shifted by ELOS: an Evidence-based Training Phase that utilizes supervised learning and a Therapeutic Optimization Phase grounds in reinforcement learning within the gradient space, explores optimal medications by perturbations from ELOS. Evaluation of the Medical Information Mart for Intensive Care III dataset and IV dataset, showcased the superior results of our model across five metrics, particularly in reducing the ELOS. Surprisingly, our model provides structural attributes of medication combinations proved in hyperbolic space and advocated "procedure-specific" medication combinations. These findings posit that MiranDa enhanced medication efficacy. Notably, our paradigm can be applied to nearly all medical tasks and those with information to evaluate predicted outcomes. The source code of the MiranDa model is available at https://github.com/azusakou/MiranDa.

Medication recommendation combines patient medical history with biomedical knowledge to assist doctors in determining medication combinations more accurately and safely. Existing works based on molecular knowledge neglect the 3D geometric structure of molecules and fail to learn the high-dimensional information of medications, leading to structural confusion. Additionally, it does not extract key substructures from a single patient visit, resulting in the failure to identify medication molecules suitable for the current patient visit. To address the above limitations, we propose a bimodal molecular recommendation framework named BiMoRec, which introduces 3D molecular structures to obtain atomic 3D coordinates and edge indices, overcoming the inherent lack of high-dimensional molecular information in 2D molecular structures. To retain the fast training and prediction efficiency of the recommendation system, we use bimodal graph contrastive pretraining to maximize the mutual information between the two molecular modalities, achieving the fusion of 2D and 3D molecular graphs and re-evaluating substructures at the visit level. Specifically, we use deep learning networks to construct a pretraining method that acquires 2D and 3D molecular structure representations and substructure representations, and obtain mutual information through contrastive learning. We then generate fused molecular representations using the trained GNN module and re-determine the relevance of substructure representations in combination with the patient's clinical history. Finally, we generate the final medication combination based on the extracted substructure sequences. Our implementation on the MIMIC-III and MIMIC-IV datasets demonstrates that our method achieves state-of-the-art performance. Compared to the second-best baseline, our model improves accuracy by 2.07%, with DDI at the same level as the baseline.

Medication recommendation systems are designed to deliver personalized drug suggestions that are closely aligned with individual patient needs. Previous studies have primarily concentrated on developing medication embeddings, achieving significant progress. Nonetheless, these approaches often fall short in accurately reflecting individual patient profiles, mainly due to challenges in distinguishing between various patient conditions and the inability to establish precise correlations between specific conditions and appropriate medications. In response to these issues, we introduce DisMed, a model that focuses on patient conditions to enhance personalization. DisMed employs causal inference to discern clear, quantifiable causal links. It then examines patient conditions in depth, recognizing and adapting to the evolving nuances of these conditions, and mapping them directly to corresponding medications. Additionally, DisMed leverages data from multiple patient visits to propose combinations of medications. Comprehensive testing on real-world datasets demonstrates that DisMed not only improves the customization of patient profiles but also surpasses leading models in both precision and safety.

As medical demands grow and machine learning technology advances, AI-based diagnostic and treatment systems are garnering increasing attention. Medication recommendation aims to integrate patients' long-term health records with medical knowledge, recommending accuracy and safe medication combinations for specific conditions. However, most existing researches treat medication recommendation systems merely as variants of traditional recommendation systems, overlooking the heterogeneity between medications and diseases. To address this challenge, we propose DGMed, a framework for medication recommendation. DGMed utilizes causal inference to uncover the connections among medical entities and presents an innovative feature alignment method to tackle heterogeneity issues. Specifically, this study first applies causal inference to analyze the quantified therapeutic effects of medications on specific diseases from historical records, uncovering potential links between medical entities. Subsequently, we integrate molecular-level knowledge, aligning the embeddings of medications and diseases within the molecular space to effectively tackle their heterogeneity. Ultimately, based on relationships at the entity level, we adaptively adjust the recommendation probabilities of medication and recommend medication combinations according to the patient's current health condition. Experimental results on a real-world dataset show that our method surpasses existing state-of-the-art baselines in four evaluation metrics, demonstrating superior performance in both accuracy and safety aspects. Compared to the sub-optimal model, our approach improved accuracy by 4.40%, reduced the risk of side effects by 6.14%, and increased time efficiency by 47.15%.

With the growing imbalance between limited medical resources and escalating demands, AI-based clinical tasks have become paramount. As a sub-domain, medication recommendation aims to amalgamate longitudinal patient history with medical knowledge, assisting physicians in prescribing safer and more accurate medication combinations. Existing works ignore the inherent long-tailed distribution of medical data, have uneven learning strengths for hot and sparse data, and fail to balance safety and accuracy. To address the above limitations, we propose StratMed, which introduces a stratification strategy that overcomes the long-tailed problem and achieves fuller learning of sparse data. It also utilizes a dual-property network to address the issue of mutual constraints on the safety and accuracy of medication combinations, synergistically enhancing these two properties. Specifically, we construct a pre-training method using deep learning networks to obtain medication and disease representations. After that, we design a pyramid-like stratification method based on relevance to strengthen the expressiveness of sparse data. Based on this relevance, we design two graph structures to express medication safety and precision at the same level to obtain patient representations. Finally, the patient's historical clinical information is fitted to generate medication combinations for the current health condition. We employed the MIMIC-III dataset to evaluate our model against state-of-the-art methods in three aspects comprehensively. Compared to the sub-optimal baseline model, our model reduces safety risk by 15.08\%, improves accuracy by 0.36\%, and reduces training time consumption by 81.66\%.

Recent progress in deep learning is revolutionizing the healthcare domain including providing solutions to medication recommendations, especially recommending medication combination for patients with complex health conditions. Existing approaches either do not customize based on patient health history, or ignore existing knowledge on drug-drug interactions (DDI) that might lead to adverse outcomes. To fill this gap, we propose the Graph Augmented Memory Networks (GAMENet), which integrates the drug-drug interactions knowledge graph by a memory module implemented as a graph convolutional networks, and models longitudinal patient records as the query. It is trained end-to-end to provide safe and personalized recommendation of medication combination. We demonstrate the effectiveness and safety of GAMENet by comparing with several state-of-the-art methods on real EHR data. GAMENet outperformed all baselines in all effectiveness measures, and also achieved 3.60% DDI rate reduction from existing EHR data.