Estimating Trustworthy and Safe Optimal Treatment Regimes

Recent statistical and reinforcement learning methods have significantly advanced patient care strategies. However, these approaches face substantial challenges in high-stakes contexts, including missing data, inherent stochasticity, and the critical requirements for interpretability and patient safety. Our work operationalizes a safe and interpretable framework to identify optimal treatment regimes. This approach involves matching patients with similar medical and pharmacological characteristics, allowing us to construct an optimal policy via interpolation. We perform a comprehensive simulation study to demonstrate the framework's ability to identify optimal policies even in complex settings. Ultimately, we operationalize our approach to study regimes for treating seizures in critically ill patients. Our findings strongly support personalized treatment strategies based on a patient's medical history and pharmacological features. Notably, we identify that reducing medication doses for patients with mild and brief seizure episodes while adopting aggressive treatment for patients in intensive care unit experiencing intense seizures leads to more favorable outcomes.

From Feature Importance to Distance Metric: An Almost Exact Matching Approach for Causal Inference

Our goal is to produce methods for observational causal inference that are auditable, easy to troubleshoot, yield accurate treatment effect estimates, and scalable to high-dimensional data. We describe an almost-exact matching approach that achieves these goals by (i) learning a distance metric via outcome modeling, (ii) creating matched groups using the distance metric, and (iii) using the matched groups to estimate treatment effects. Our proposed method uses variable importance measurements to construct a distance metric, making it a flexible method that can be adapted to various applications. Concentrating on the scalability of the problem in the number of potential confounders, we operationalize our approach with LASSO. We derive performance guarantees for settings where LASSO outcome modeling consistently identifies all confounders (importantly without requiring the linear model to be correctly specified). We also provide experimental results demonstrating the auditability of matches, as well as extensions to more general nonparametric outcome modeling.