MedFeat: Model-Aware and Explainability-Driven Feature Engineering with LLMs for Clinical Tabular Prediction

Abstract

In healthcare tabular predictions, classical models with feature engineering often outperform neural approaches. Recent advances in Large Language Models enable the integration of domain knowledge into feature engineering, offering a promising direction. However, existing approaches typically rely on a broad search over predefined transformations, overlooking downstream model characteristics and feature importance signals. We present MedFeat, a feedback-driven and model-aware feature engineering framework that leverages LLM reasoning with domain knowledge and provides feature explanations based on SHAP values while tracking successful and failed proposals to guide feature discovery. By incorporating model awareness, MedFeat prioritizes informative signals that are difficult for the downstream model to learn directly due to its characteristics. Across a broad range of clinical prediction tasks, MedFeat achieves stable improvements over various baselines and discovers clinically meaningful features that generalize under distribution shift, demonstrating robustness across years and from ICU cohorts to general hospitalized patients, thereby offering insights into real-world deployment. Code required to reproduce our experiments will be released, subject to dataset agreements and institutional policies.

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