Learning Sequential Decisions from Multiple Sources via Group-Robust Markov Decision Processes

We often collect data from multiple sites (e.g., hospitals) that share common structure but also exhibit heterogeneity. This paper aims to learn robust sequential decision-making policies from such offline, multi-site datasets. To model cross-site uncertainty, we study distributionally robust MDPs with a group-linear structure: all sites share a common feature map, and both the transition kernels and expected reward functions are linear in these shared features. We introduce feature-wise (d-rectangular) uncertainty sets, which preserve tractable robust Bellman recursions while maintaining key cross-site structure. Building on this, we then develop an offline algorithm based on pessimistic value iteration that includes: (i) per-site ridge regression for Bellman targets, (ii) feature-wise worst-case (row-wise minimization) aggregation, and (iii) a data-dependent pessimism penalty computed from the diagonals of the inverse design matrices. We further propose a cluster-level extension that pools similar sites to improve sample efficiency, guided by prior knowledge of site similarity. Under a robust partial coverage assumption, we prove a suboptimality bound for the resulting policy. Overall, our framework addresses multi-site learning with heterogeneous data sources and provides a principled approach to robust planning without relying on strong state-action rectangularity assumptions.

Semi-supervised Clustering Through Representation Learning of Large-scale EHR Data

Electronic Health Records (EHR) offer rich real-world data for personalized medicine, providing insights into disease progression, treatment responses, and patient outcomes. However, their sparsity, heterogeneity, and high dimensionality make them difficult to model, while the lack of standardized ground truth further complicates predictive modeling. To address these challenges, we propose SCORE, a semi-supervised representation learning framework that captures multi-domain disease profiles through patient embeddings. SCORE employs a Poisson-Adapted Latent factor Mixture (PALM) Model with pre-trained code embeddings to characterize codified features and extract meaningful patient phenotypes and embeddings. To handle the computational challenges of large-scale data, it introduces a hybrid Expectation-Maximization (EM) and Gaussian Variational Approximation (GVA) algorithm, leveraging limited labeled data to refine estimates on a vast pool of unlabeled samples. We theoretically establish the convergence of this hybrid approach, quantify GVA errors, and derive SCORE's error rate under diverging embedding dimensions. Our analysis shows that incorporating unlabeled data enhances accuracy and reduces sensitivity to label scarcity. Extensive simulations confirm SCORE's superior finite-sample performance over existing methods. Finally, we apply SCORE to predict disability status for patients with multiple sclerosis (MS) using partially labeled EHR data, demonstrating that it produces more informative and predictive patient embeddings for multiple MS-related conditions compared to existing approaches.

Representation Learning to Advance Multi-institutional Studies with Electronic Health Record Data

The adoption of EHRs has expanded opportunities to leverage data-driven algorithms in clinical care and research. A major bottleneck in effectively conducting multi-institutional EHR studies is the data heterogeneity across systems with numerous codes that either do not exist or represent different clinical concepts across institutions. The need for data privacy further limits the feasibility of including multi-institutional patient-level data required to study similarities and differences across patient subgroups. To address these challenges, we developed the GAME algorithm. Tested and validated across 7 institutions and 2 languages, GAME integrates data in several levels: (1) at the institutional level with knowledge graphs to establish relationships between codes and existing knowledge sources, providing the medical context for standard codes and their relationship to each other; (2) between institutions, leveraging language models to determine the relationships between institution-specific codes with established standard codes; and (3) quantifying the strength of the relationships between codes using a graph attention network. Jointly trained embeddings are created using transfer and federated learning to preserve data privacy. In this study, we demonstrate the applicability of GAME in selecting relevant features as inputs for AI-driven algorithms in a range of conditions, e.g., heart failure, rheumatoid arthritis. We then highlight the application of GAME harmonized multi-institutional EHR data in a study of Alzheimer's disease outcomes and suicide risk among patients with mental health disorders, without sharing patient-level data outside individual institutions.