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New financial incentives, such as reduced Medicare reimbursements, have led hospitals to closely monitor their readmission rates and initiate efforts aimed at reducing them. In this context, many surgical departments participate in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which collects detailed demographic, laboratory, clinical, procedure and perioperative occurrence data. The availability of such data enables the development of data science methods which predict readmissions and, as done in this paper, offer specific recommendations aimed at preventing readmissions. This study leverages NSQIP data for 722,101 surgeries to develop predictive and prescriptive models, predicting readmissions and offering real-time, personalized treatment recommendations for surgical patients during their hospital stay, aimed at reducing the risk of a 30-day readmission. We applied a variety of classification methods to predict 30-day readmissions and developed two prescriptive methods to recommend pre-operative blood transfusions to increase the patient's hematocrit with the objective of preventing readmissions. The effect of these interventions was evaluated using several predictive models. Predictions of 30-day readmissions based on the entire collection of NSQIP variables achieve an out-of-sample accuracy of 87% (Area Under the Curve-AUC). Predictions based only on pre-operative variables have an accuracy of 74% AUC, out-of-sample. Personalized interventions, in the form of pre-operative blood transfusions identified by the prescriptive methods, reduce readmissions by 12%, on average, for patients considered as candidates for pre-operative transfusion (pre-operative hematoctic <30). The prediction accuracy of the proposed models exceeds results in the literature. This study is among the first to develop a methodology for making specific, data-driven, personalized treatment recommendations to reduce the 30-day readmission rate. The reported predicted reduction in readmissions can lead to more than $20 million in savings in the U.S. annually.

This paper presents a novel holistic deep learning framework that simultaneously addresses the challenges of vulnerability to input perturbations, overparametrization, and performance instability from different train-validation splits. The proposed framework holistically improves accuracy, robustness, sparsity, and stability over standard deep learning models, as demonstrated by extensive experiments on both tabular and image data sets. The results are further validated by ablation experiments and SHAP value analysis, which reveal the interactions and trade-offs between the different evaluation metrics. To support practitioners applying our framework, we provide a prescriptive approach that offers recommendations for selecting an appropriate training loss function based on their specific objectives. All the code to reproduce the results can be found at https://github.com/kimvc7/HDL .

Disease modelling has had considerable policy impact during the ongoing COVID-19 pandemic, and it is increasingly acknowledged that combining multiple models can improve the reliability of outputs. Here we report insights from ten weeks of collaborative short-term forecasting of COVID-19 in Germany and Poland (12 October–19 December 2020). The study period covers the onset of the second wave in both countries, with tightening non-pharmaceutical interventions (NPIs) and subsequently a decay (Poland) or plateau and renewed increase (Germany) in reported cases. Thirteen independent teams provided probabilistic real-time forecasts of COVID-19 cases and deaths. These were reported for lead times of one to four weeks, with evaluation focused on one- and two-week horizons, which are less affected by changing NPIs. Heterogeneity between forecasts was considerable both in terms of point predictions and forecast spread. Ensemble forecasts showed good relative performance, in particular in terms of coverage, but did not clearly dominate single-model predictions. The study was preregistered and will be followed up in future phases of the pandemic. Forecasting models have been used extensively to inform decision making during the COVID-19 pandemic. In this preregistered and prospective study, the authors evaluated 14 short-term models for Germany and Poland, finding considerable heterogeneity in predictions and highlighting the benefits of combined forecasts.

The COVID-19 pandemic has created unprecedented challenges worldwide. Strained healthcare providers make difficult decisions on patient triage, treatment and care management on a daily basis. Policy makers have imposed social distancing measures to slow the disease, at a steep economic price. We design analytical tools to support these decisions and combat the pandemic. Specifically, we propose a comprehensive data-driven approach to understand the clinical characteristics of COVID-19, predict its mortality, forecast its evolution, and ultimately alleviate its impact. By leveraging cohort-level clinical data, patient-level hospital data, and census-level epidemiological data, we develop an integrated four-step approach, combining descriptive, predictive and prescriptive analytics. First, we aggregate hundreds of clinical studies into the most comprehensive database on COVID-19 to paint a new macroscopic picture of the disease. Second, we build personalized calculators to predict the risk of infection and mortality as a function of demographics, symptoms, comorbidities, and lab values. Third, we develop a novel epidemiological model to project the pandemic’s spread and inform social distancing policies. Fourth, we propose an optimization model to re-allocate ventilators and alleviate shortages. Our results have been used at the clinical level by several hospitals to triage patients, guide care management, plan ICU capacity, and re-distribute ventilators. At the policy level, they are currently supporting safe back-to-work policies at a major institution and vaccine trial location planning at Janssen Pharmaceuticals, and have been integrated into the US Center for Disease Control’s pandemic forecast.

IntroductionNew financial incentives, such as reduced Medicare reimbursements, have led hospitals to closely monitor their readmission rates and initiate efforts aimed at reducing them. In this context, many surgical departments participate in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which collects detailed demographic, laboratory, clinical, procedure and perioperative occurrence data. The availability of such data enables the development of data science methods which predict readmissions and, as done in this paper, offer specific recommendations aimed at preventing readmissions.Materials and methodsThis study leverages NSQIP data for 722,101 surgeries to develop predictive and prescriptive models, predicting readmissions and offering real-time, personalized treatment recommendations for surgical patients during their hospital stay, aimed at reducing the risk of a 30-day readmission. We applied a variety of classification methods to predict 30-day readmissions and developed two prescriptive methods to recommend pre-operative blood transfusions to increase the patient's hematocrit with the objective of preventing readmissions. The effect of these interventions was evaluated using several predictive models.ResultsPredictions of 30-day readmissions based on the entire collection of NSQIP variables achieve an out-of-sample accuracy of 87% (Area Under the Curve-AUC). Predictions based only on pre-operative variables have an accuracy of 74% AUC, out-of-sample. Personalized interventions, in the form of pre-operative blood transfusions identified by the prescriptive methods, reduce readmissions by 12%, on average, for patients considered as candidates for pre-operative transfusion (pre-operative hematoctic <30). The prediction accuracy of the proposed models exceeds results in the literature.ConclusionsThis study is among the first to develop a methodology for making specific, data-driven, personalized treatment recommendations to reduce the 30-day readmission rate. The reported predicted reduction in readmissions can lead to more than $20 million in savings in the U.S. annually.

The increasing availability of individual-level data has led to numerous applications of individualized (or personalized) treatment rules (ITRs). Policy makers often wish to empirically evaluate ITRs and compare their relative performance before implementing them in a target population. We propose a new evaluation metric, the population average prescriptive effect (PAPE). The PAPE compares the performance of ITR with that of non-individualized treatment rule, which randomly treats the same proportion of units. Averaging the PAPE over a range of budget constraints yields our second evaluation metric, the area under the prescriptive effect curve (AUPEC). The AUPEC represents an overall performance measure for evaluation, like the area under the receiver and operating characteristic curve (AUROC) does for classification, and is a generalization of the QINI coefficient utilized in uplift modeling. We use Neyman's repeated sampling framework to estimate the PAPE and AUPEC and derive their exact finite-sample variances based on random sampling of units and random assignment of treatment. We extend our methodology to a common setting, in which the same experimental data is used to both estimate and evaluate ITRs. In this case, our variance calculation incorporates the additional uncertainty due to random splits of data used for cross-validation. The proposed evaluation metrics can be estimated without requiring modeling assumptions, asymptotic approximation, or resampling methods. As a result, it is applicable to any ITR including those based on complex machine learning algorithms. The open-source software package is available for implementing the proposed methodology.

The surge in data availability has inundated decision-makers with an overwhelming array of choices. While existing approaches focus on optimizing decisions based on quantifiable metrics, practical decision-making often requires balancing measurable quantitative criteria with unmeasurable qualitative factors embedded in the broader context. In such cases, algorithms can generate high-quality recommendations, but the final decision rests with the human, who must weigh both dimensions. We define the process of selecting the optimal set of algorithmic recommendations in this context as human-centered decision making. To address this challenge, we introduce a novel framework called generative curation, which optimizes the true desirability of decision options by integrating both quantitative and qualitative aspects. Our framework uses a Gaussian process to model unknown qualitative factors and derives a diversity metric that balances quantitative optimality with qualitative diversity. This trade-off enables the generation of a manageable subset of diverse, near-optimal actions that are robust to unknown qualitative preferences. To operationalize this framework, we propose two implementation approaches: a generative neural network architecture that produces a distribution \\(\\pi\\) to efficiently sample a diverse set of near-optimal actions, and a sequential optimization method to iteratively generates solutions that can be easily incorporated into complex optimization formulations. We validate our approach with extensive datasets, demonstrating its effectiveness in enhancing decision-making processes across a range of complex environments, with significant implications for policy and management.

We define an online learning and optimization problem with irreversible decisions contributing toward a coverage target. At each period, a decision-maker selects facilities to open, receives information on the success of each one, and updates a machine learning model to guide future decisions. The goal is to minimize costs across a finite horizon under a chance constraint reflecting the coverage target. We derive an optimal algorithm and a tight lower bound in an asymptotic regime characterized by a large target number of facilities \\(m\\to\\infty\\) but a finite horizon \\(T\\in\\mathbb{Z}_+\\). We find that the regret grows sub-linearly at a rate \\(\\Theta\\left(m^{\\frac{1}{2}\\cdot\\frac{1}{1-2^{-T}}}\\right)\\), thus converging exponentially fast to \\(\\Theta(\\sqrt{m})\\). We establish the robustness of this result to the learning environment; we also extend it to a more complicated facility location setting in a bipartite facility-customer graph with a target on customer coverage. Throughout, constructive proofs identify a policy featuring limited exploration initially for learning purposes, and fast exploitation later on for optimization purposes once uncertainty gets mitigated. These findings underscore the benefits of limited online learning and optimization, in that even a few rounds can provide significant benefits as compared to a no-learning baseline.

Researchers are increasingly turning to machine learning (ML) algorithms to investigate causal heterogeneity in randomized experiments. Despite their promise, ML algorithms may fail to accurately ascertain heterogeneous treatment effects under practical settings with many covariates and small sample size. In addition, the quantification of estimation uncertainty remains a challenge. We develop a general approach to statistical inference for heterogeneous treatment effects discovered by a generic ML algorithm. We apply the Neyman's repeated sampling framework to a common setting, in which researchers use an ML algorithm to estimate the conditional average treatment effect and then divide the sample into several groups based on the magnitude of the estimated effects. We show how to estimate the average treatment effect within each of these groups, and construct a valid confidence interval. In addition, we develop nonparametric tests of treatment effect homogeneity across groups, and rank-consistency of within-group average treatment effects. The validity of our methodology does not rely on the properties of ML algorithms because it is solely based on the randomization of treatment assignment and random sampling of units. Finally, we generalize our methodology to the cross-fitting procedure by accounting for the additional uncertainty induced by the random splitting of data.

We propose a new scalable algorithm for holistic linear regression building on Bertsimas & King (2016). Specifically, we develop new theory to model significance and multicollinearity as lazy constraints rather than checking the conditions iteratively. The resulting algorithm scales with the number of samples \\(n\\) in the 10,000s, compared to the low 100s in the previous framework. Computational results on real and synthetic datasets show it greatly improves from previous algorithms in accuracy, false detection rate, computational time and scalability.