Collaborating Authors

Zhang, Linying

The Medical Deconfounder: Assessing Treatment Effect with Electronic Health Records (EHRs) Machine Learning

Causal estimation of treatment effect has an important role in guiding physicians' decision process for drug prescription. While treatment effect is classically assessed with randomized controlled trials (RCTs), the availability of electronic health records (EHRs) bring an unprecedented opportunity for more efficient estimation. However, the presence of unobserved confounders makes treatment effect assessment from EHRs a challenging task. Confounders are the variables that affect both drug prescription and the patient's outcome; examples include a patient's gender, race, social economic status and comorbidities. When these confounders are unobserved, they bias the estimation. To adjust for unobserved confounders, we develop the medical deconfounder, a machine learning algorithm that unbiasedly estimates treatment effect from EHRs. The medical deconfounder first constructs a substitute confounder by modeling which drugs were prescribed to each patient; this substitute confounder is guaranteed to capture all multi-drug confounders, observed or unobserved (Wang and Blei, 2018). It then uses this substitute confounder to adjust for the confounding bias in the analysis. We validate the medical deconfounder on simulations and two medical data sets. The medical deconfounder produces closer-to-truth estimates in simulations and identifies effective medications that are more consistent with the findings reported in the medical literature compared to classical approaches.

Evaluating Reinforcement Learning Algorithms in Observational Health Settings Machine Learning

Much attention has been devoted recently to the development of machine learning algorithms with the goal of improving treatment policies in healthcare. Reinforcement learning (RL) is a sub-field within machine learning that is concerned with learning how to make sequences of decisions so as to optimize long-term effects. Already, RL algorithms have been proposed to identify decision-making strategies for mechanical ventilation, sepsis management and treatment of schizophrenia. However, before implementing treatment policies learned by black-box algorithms in high-stakes clinical decision problems, special care must be taken in the evaluation of these policies. In this document, our goal is to expose some of the subtleties associated with evaluating RL algorithms in healthcare. We aim to provide a conceptual starting point for clinical and computational researchers to ask the right questions when designing and evaluating algorithms for new ways of treating patients. In the following, we describe how choices about how to summarize a history, variance of statistical estimators, and confounders in more ad-hoc measures can result in unreliable, even misleading estimates of the quality of a treatment policy. We also provide suggestions for mitigating these effects---for while there is much promise for mining observational health data to uncover better treatment policies, evaluation must be performed thoughtfully.