GraphBEAT: Graph-based Bucketized Event Aggregation Over Time for Early Risk Stratification of Gastrointestinal Cancers

Longitudinal electronic health records (EHRs) can reveal disease-progression structure, while useful forecasting requires leakage-controlled discovery, censor-aware outcomes, and inspectable trajectory evidence. We developed a graph-enhanced framework in MIMIC-IV v3.1 that splits patients before graph construction, learns train-only consecutive-admission transitions, and freezes endpoint-specific branching-motif policies selected on validation data. The final catalog contained 99,527 motifs, and a time-aware Transformer retrieved at most 24 patient-compatible motifs per endpoint through endpoint-specific cross-attention. Across five training seeds, micro-AUPRC increased from 0.9330 to 0.9357, while event-time MAE decreased from 676.9 to 657.7 days (reduction 19.2 days; 95% paired patient-cluster bootstrap CI, 13.8-24.8). Timing effects were heterogeneous: MAE worsened for events within 730 days but improved by 58.9 days for events occurring after 730 days. In an exploratory internal temporal split, branch conditioning reduced conditional event-time MAE by 26.9 days (95% CI, 23.0-30.8) without evidence of better micro-AUPRC. Corrected survival evaluation over the supported 0-2,555-day interval did not establish macro C-index or integrated Brier score superiority over a matched history-only discrete-hazard model. A directed, degree-matched GNN repair substantially improved unseen-edge discovery, yet replacing GNN-derived scores within fixed motif identities did not improve downstream forecasting. These results position branching motifs as structured trajectory context whose main value is long-range timing support rather than uniformly stronger endpoint discrimination, survival prediction, or causal explanation.

The growing adoption of electronic health record (EHR) systems has provided unprecedented opportunities for predictive modeling to guide clinical decision making. Structured EHRs contain longitudinal observations of patients across hospital visits, where each visit is represented by a set of medical codes. While sequence-based, graph-based, and graph-enhanced sequence approaches have been developed to capture rich code interactions over time or within the same visits, they often overlook the inherent heterogeneous roles of medical codes arising from distinct clinical characteristics and contexts. To this end, in this study we propose the Disease Trajectory-aware Transformer for EHR (DT-BEHRT), a graph-enhanced sequential architecture that disentangles disease trajectories by explicitly modeling diagnosis-centric interactions within organ systems and capturing asynchronous progression patterns. To further enhance the representation robustness, we design a tailored pre-training methodology that combines trajectory-level code masking with ontology-informed ancestor prediction, promoting semantic alignment across multiple modeling modules. Extensive experiments on multiple benchmark datasets demonstrate that DT-BEHRT achieves strong predictive performance and provides interpretable patient representations that align with clinicians' disease-centered reasoning. The source code is publicly accessible at https://github.com/GatorAIM/DT-BEHRT.git.

Learning from Electronic Health Records (EHRs) has gained significant attention due to its potential to improve clinical prediction. However, effective learning remains challenging because EHRs encode heterogeneous, temporally ordered clinical interactions. In particular, EHRs contain: (i) heterogeneous clinical entities, including patients, visits, diagnoses, prescriptions, and procedures, together with their heterogeneous interactions, (ii) longitudinal patient trajectories across hospital visits and (iii) shared statistical dependencies across related clinical prediction tasks. Existing EHR learning methods capture only a subset of these properties. To bridge this gap, we propose Multi-task Graph transformer for Heterogeneous Temporal EHRs (MiGHT-EHR), which jointly models all three within a unified representation learning method. MiGHT-EHR constructs a heterogeneous graph from EHRs in which nodes represent clinical entities and edges connect statistically associated entities identified via normalized point-wise mutual information. Across MIMIC-III and MIMIC-IV datasets, MiGHT-EHR outperforms state-of-the-art methods on average across four tasks: drug recommendation, prediction of length-of-stay, mortality, and readmission, with particularly strong improvements in mortality and readmission prediction. Furthermore, a post-hoc analysis of the learned representations reveals that patient neighborhoods are organized by clinical outcomes, salient medical concepts are recoverable as linear directions in the representation space, and task probabilities are well calibrated. Collectively, these findings demonstrate that MiGHT-EHR representations support diverse prediction tasks while preserving clinically interpretable structure.