Wearable devices record physiological and behavioral signals that can improve health predictions. While foundation models are increasingly used for such predictions, they have been primarily applied to low-level sensor data, despite behavioral data often being more informative due to their alignment with physiologically relevant timescales and quantities. We develop foundation models of such behavioral signals using over 2.5B hours of wearable data from 162K individuals, systematically optimizing architectures and tokenization strategies for this unique dataset. Evaluated on 57 health-related tasks, our model shows strong performance across diverse real-world applications including individual-level classification and time-varying health state prediction. The model excels in behavior-driven tasks like sleep prediction, and improves further when combined with representations of raw sensor data. These results underscore the importance of tailoring foundation model design to wearables and demonstrate the potential to enable new health applications.

Many medical decision-making tasks can be framed as partially observed Markov decision processes (POMDPs). However, prevailing two-stage approaches that first learn a POMDP and then solve it often fail because the model that best fits the data may not be well suited for planning. We introduce a new optimization objective that (a) produces both high-performing policies and high-quality generative models, even when some observations are irrelevant for planning, and (b) does so in batch off-policy settings that are typical in healthcare, when only retrospective data is available. We demonstrate our approach on synthetic examples and a challenging medical decision-making problem.

Off-policy evaluation in reinforcement learning offers the chance of using observational data to improve future outcomes in domains such as healthcare and education, but safe deployment in high stakes settings requires ways of assessing its validity. Traditional measures such as confidence intervals may be insufficient due to noise, limited data and confounding. In this paper we develop a method that could serve as a hybrid human-AI system, to enable human experts to analyze the validity of policy evaluation estimates. This is accomplished by highlighting observations in the data whose removal will have a large effect on the OPE estimate, and formulating a set of rules for choosing which ones to present to domain experts for validation. We develop methods to compute exactly the influence functions for fitted Q-evaluation with two different function classes: kernel-based and linear least squares, as well as importance sampling methods. Experiments on medical simulations and real-world intensive care unit data demonstrate that our method can be used to identify limitations in the evaluation process and make evaluation more robust.

We present two elegant solutions for modeling continuous-time dynamics, in a novel model-based reinforcement learning (RL) framework for semi-Markov decision processes (SMDPs), using neural ordinary differential equations (ODEs). Our models accurately characterize continuous-time dynamics and enable us to develop high-performing policies using a small amount of data. We also develop a model-based approach for optimizing time schedules to reduce interaction rates with the environment while maintaining the near-optimal performance, which is not possible for model-free methods. We experimentally demonstrate the efficacy of our methods across various continuous-time domains.

We present a scalable end-to-end classifier that uses streaming physiological and medication data to accurately predict the onset of sepsis, a life-threatening complication from infections that has high mortality and morbidity. Our proposed framework models the multivariate trajectories of continuous-valued physiological time series using multitask Gaussian processes, seamlessly accounting for the high uncertainty, frequent missingness, and irregular sampling rates typically associated with real clinical data. The Gaussian process is directly connected to a black-box classifier that predicts whether a patient will become septic, chosen in our case to be a recurrent neural network to account for the extreme variability in the length of patient encounters. We show how to scale the computations associated with the Gaussian process in a manner so that the entire system can be discriminatively trained end-to-end using backpropagation. In a large cohort of heterogeneous inpatient encounters at our university health system we find that it outperforms several baselines at predicting sepsis, and yields 19.4\% and 55.5\% improved areas under the Receiver Operating Characteristic and Precision Recall curves as compared to the NEWS score currently used by our hospital.

Risk sharing arrangements between hospitals and payers together with penalties imposed by the Centers for Medicare and Medicaid (CMS) are driving an interest in decreasing early readmissions. There are a number of published risk models predicting 30day readmissions for particular patient populations, however they often exhibit poor predictive performance and would be unsuitable for use in a clinical setting. In this work we describe and compare several predictive models, some of which have never been applied to this task and which outperform the regression methods that are typically applied in the healthcare literature. In addition, we apply methods from deep learning to the five conditions CMS is using to penalize hospitals, and offer a simple framework for determining which conditions are most cost effective to target.

We present a general construction for dependent random measures based on thinning Poisson processes on an augmented space. The framework is not restricted to dependent versions of a specific nonparametric model, but can be applied to all models that can be represented using completely random measures. Several existing dependent random measures can be seen as specific cases of this framework. Interesting properties of the resulting measures are derived and the efficacy of the framework is demonstrated by constructing a covariate-dependent latent feature model and topic model that obtain superior predictive performance.