Closing the Gap in High-Risk Pregnancy Care Using Machine Learning and Human-AI Collaboration

Health insurers often use algorithms to identify members who would benefit from care and condition management programs, which provide personalized, high-touch clinical support. Timely, accurate, and seamless integration between algorithmic identification and clinical intervention depends on effective collaboration between the system designers and nurse care managers. We focus on a high-risk pregnancy (HRP) program designed to reduce the likelihood of adverse prenatal, perinatal, and postnatal events and describe how we overcome three challenges of HRP programs as articulated by nurse care managers; (1) early detection of pregnancy, (2) accurate identification of impactable high-risk members, and (3) provision of explainable indicators to supplement predictions. We propose a novel algorithm for pregnancy identification that identifies pregnancies 57 days earlier than previous code-based models in a retrospective study. We then build a model to predict impactable pregnancy complications that achieves an AUROC of 0.760. Models for pregnancy identification and complications are then integrated into a proposed user interface. In a set of user studies, we collected quantitative and qualitative feedback from nurses on the utility of the predictions combined with clinical information driving the predictions on triaging members for the HRP program.

Large-Scale Study of Temporal Shift in Health Insurance Claims

Most machine learning models for predicting clinical outcomes are developed using historical data. Yet, even if these models are deployed in the near future, dataset shift over time may result in less than ideal performance. To capture this phenomenon, we consider a task--that is, an outcome to be predicted at a particular time point--to be non-stationary if a historical model is no longer optimal for predicting that outcome. We build an algorithm to test for temporal shift either at the population level or within a discovered sub-population. Then, we construct a meta-algorithm to perform a retrospective scan for temporal shift on a large collection of tasks. Our algorithms enable us to perform the first comprehensive evaluation of temporal shift in healthcare to our knowledge. We create 1,010 tasks by evaluating 242 healthcare outcomes for temporal shift from 2015 to 2020 on a health insurance claims dataset. 9.7% of the tasks show temporal shifts at the population level, and 93.0% have some sub-population affected by shifts. We dive into case studies to understand the clinical implications. Our analysis highlights the widespread prevalence of temporal shifts in healthcare.

Beyond Summarization: Designing AI Support for Real-World Expository Writing Tasks

Large language models have introduced exciting new opportunities and challenges in designing and developing new AI-assisted writing support tools. Recent work has shown that leveraging this new technology can transform writing in many scenarios such as ideation during creative writing, editing support, and summarization. However, AI-supported expository writing--including real-world tasks like scholars writing literature reviews or doctors writing progress notes--is relatively understudied. In this position paper, we argue that developing AI supports for expository writing has unique and exciting research challenges and can lead to high real-world impacts. We characterize expository writing as evidence-based and knowledge-generating: it contains summaries of external documents as well as new information or knowledge. It can be seen as the product of authors' sensemaking process over a set of source documents, and the interplay between reading, reflection, and writing opens up new opportunities for designing AI support. We sketch three components for AI support design and discuss considerations for future research.

Conformalized Unconditional Quantile Regression

We develop a predictive inference procedure that combines conformal prediction (CP) with unconditional quantile regression (QR) -- a commonly used tool in econometrics that involves regressing the recentered influence function (RIF) of the quantile functional over input covariates. Unlike the more widely-known conditional QR, unconditional QR explicitly captures the impact of changes in covariate distribution on the quantiles of the marginal distribution of outcomes. Leveraging this property, our procedure issues adaptive predictive intervals with localized frequentist coverage guarantees. It operates by fitting a machine learning model for the RIFs using training data, and then applying the CP procedure for any test covariate with respect to a ``hypothetical'' covariate distribution localized around the new instance. Experiments show that our procedure is adaptive to heteroscedasticity, provides transparent coverage guarantees that are relevant to the test instance at hand, and performs competitively with existing methods in terms of efficiency.

Falsification of Internal and External Validity in Observational Studies via Conditional Moment Restrictions

Randomized Controlled Trials (RCT)s are relied upon to assess new treatments, but suffer from limited power to guide personalized treatment decisions. On the other hand, observational (i.e., non-experimental) studies have large and diverse populations, but are prone to various biases (e.g. residual confounding). To safely leverage the strengths of observational studies, we focus on the problem of falsification, whereby RCTs are used to validate causal effect estimates learned from observational data. In particular, we show that, given data from both an RCT and an observational study, assumptions on internal and external validity have an observable, testable implication in the form of a set of Conditional Moment Restrictions (CMRs). Further, we show that expressing these CMRs with respect to the causal effect, or "causal contrast", as opposed to individual counterfactual means, provides a more reliable falsification test. In addition to giving guarantees on the asymptotic properties of our test, we demonstrate superior power and type I error of our approach on semi-synthetic and real world datasets. Our approach is interpretable, allowing a practitioner to visualize which subgroups in the population lead to falsification of an observational study.

Who Should Predict? Exact Algorithms For Learning to Defer to Humans

Automated AI classifiers should be able to defer the prediction to a human decision maker to ensure more accurate predictions. In this work, we jointly train a classifier with a rejector, which decides on each data point whether the classifier or the human should predict. We show that prior approaches can fail to find a human-AI system with low misclassification error even when there exists a linear classifier and rejector that have zero error (the realizable setting). We prove that obtaining a linear pair with low error is NP-hard even when the problem is realizable. To complement this negative result, we give a mixed-integer-linear-programming (MILP) formulation that can optimally solve the problem in the linear setting. However, the MILP only scales to moderately-sized problems. Therefore, we provide a novel surrogate loss function that is realizable-consistent and performs well empirically. We test our approaches on a comprehensive set of datasets and compare to a wide range of baselines.

TabLLM: Few-shot Classification of Tabular Data with Large Language Models

We study the application of large language models to zero-shot and few-shot classification of tabular data. We prompt the large language model with a serialization of the tabular data to a natural-language string, together with a short description of the classification problem. In the few-shot setting, we fine-tune the large language model using some labeled examples. We evaluate several serialization methods including templates, table-to-text models, and large language models. Despite its simplicity, we find that this technique outperforms prior deep-learning-based tabular classification methods on several benchmark datasets. In most cases, even zero-shot classification obtains non-trivial performance, illustrating the method's ability to exploit prior knowledge encoded in large language models. Unlike many deep learning methods for tabular datasets, this approach is also competitive with strong traditional baselines like gradient-boosted trees, especially in the very-few-shot setting.

Falsification before Extrapolation in Causal Effect Estimation

Randomized Controlled Trials (RCTs) represent a gold standard when developing policy guidelines. However, RCTs are often narrow, and lack data on broader populations of interest. Causal effects in these populations are often estimated using observational datasets, which may suffer from unobserved confounding and selection bias. Given a set of observational estimates (e.g. from multiple studies), we propose a meta-algorithm that attempts to reject observational estimates that are biased. We do so using validation effects, causal effects that can be inferred from both RCT and observational data. After rejecting estimators that do not pass this test, we generate conservative confidence intervals on the extrapolated causal effects for subgroups not observed in the RCT. Under the assumption that at least one observational estimator is asymptotically normal and consistent for both the validation and extrapolated effects, we provide guarantees on the coverage probability of the intervals output by our algorithm. To facilitate hypothesis testing in settings where causal effect transportation across datasets is necessary, we give conditions under which a doubly-robust estimator of group average treatment effects is asymptotically normal, even when flexible machine learning methods are used for estimation of nuisance parameters. We illustrate the properties of our approach on semi-synthetic and real world datasets, and show that it compares favorably to standard meta-analysis techniques.

Sample Efficient Learning of Predictors that Complement Humans

One of the goals of learning algorithms is to complement and reduce the burden on human decision makers. The expert deferral setting wherein an algorithm can either predict on its own or defer the decision to a downstream expert helps accomplish this goal. A fundamental aspect of this setting is the need to learn complementary predictors that improve on the human's weaknesses rather than learning predictors optimized for average error. In this work, we provide the first theoretical analysis of the benefit of learning complementary predictors in expert deferral. To enable efficiently learning such predictors, we consider a family of consistent surrogate loss functions for expert deferral and analyze their theoretical properties. Finally, we design active learning schemes that require minimal amount of data of human expert predictions in order to learn accurate deferral systems.

Training Subset Selection for Weak Supervision

Existing weak supervision approaches use all the data covered by weak signals to train a classifier. We show both theoretically and empirically that this is not always optimal. Intuitively, there is a tradeoff between the amount of weakly-labeled data and the precision of the weak labels. We explore this tradeoff by combining pretrained data representations with the cut statistic (Muhlenbach et al., 2004) to select (hopefully) high-quality subsets of the weakly-labeled training data. Subset selection applies to any label model and classifier and is very simple to plug in to existing weak supervision pipelines, requiring just a few lines of code. We show our subset selection method improves the performance of weak supervision for a wide range of label models, classifiers, and datasets. Using less weakly-labeled data improves the accuracy of weak supervision pipelines by up to 19% (absolute) on benchmark tasks.