Sepsis is a leading cause of mortality in intensive care units (ICUs) and costs hospitals billions annually. Treating a septic patient is highly challenging, because individual patients respond very differently to medical interventions and there is no universally agreed-upon treatment for sepsis. Understanding more about a patient's physiological state at a given time could hold the key to effective treatment policies. In this work, we propose a new approach to deduce optimal treatment policies for septic patients by using continuous state-space models and deep reinforcement learning. Learning treatment policies over continuous spaces is important, because we retain more of the patient's physiological information. Our model is able to learn clinically interpretable treatment policies, similar in important aspects to the treatment policies of physicians. Evaluating our algorithm on past ICU patient data, we find that our model could reduce patient mortality in the hospital by up to 3.6 over observed clinical policies, from a baseline mortality of 13.7 . The learned treatment policies could be used to aid intensive care clinicians in medical decision making and improve the likelihood of patient survival.
@cite_0 applied deep RL techniques to modeling ICU heparin dosing as a Partially Observed Markov Decision Process (POMDP), using both discriminative Hidden Markov Models and Q-networks to discover the optimal policy. Their investigation was made more challenging by the relatively small amount of available data. @cite_2 learned optimal treatment policies for schizophrenic patients, and quantified the uncertainty around the expected outcome for patients who followed the policies. @cite_1 use off-policy reinforcement learning algorithms to determine ICU strategies for mechanical ventilation administration and weaning, but focus on simpler learning algorithms and a heuristic action space. We experiment with using a sparse autoencoder to generate latent representations of the state of a patient, likely leading to an easier learning problem. We also propose neural network architectures that obtain more robust methods for optimal policy deduction.
@cite_0 @cite_1 @cite_2
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Misdosing medications with sensitive therapeutic windows, such as heparin, can place patients at unnecessary risk, increase length of hospital stay, and lead to wasted hospital resources. In this work, we present a clinician-in-the-loop sequential decision making framework, which provides an individualized dosing policy adapted to each patient's evolving clinical phenotype. We employed retrospective data from the publicly available MIMIC II intensive care unit database, and developed a deep reinforcement learning algorithm that learns an optimal heparin dosing policy from sample dosing trails and their associated outcomes in large electronic medical records. Using separate training and testing datasets, our model was observed to be effective in proposing heparin doses that resulted in better expected outcomes than the clinical guidelines. Our results demonstrate that a sequential modeling approach, learned from retrospective data, could potentially be used at the bedside to derive individualized patient dosing policies. Dynamic treatment recommendation systems based on large-scale electronic health records (EHRs) become a key to successfully improve practical clinical outcomes. Prior relevant studies recommend treatments either use supervised learning (e.g. matching the indicator signal which denotes doctor prescriptions), or reinforcement learning (e.g. maximizing evaluation signal which indicates cumulative reward from survival rates). However, none of these studies have considered to combine the benefits of supervised learning and reinforcement learning. In this paper, we propose Supervised Reinforcement Learning with Recurrent Neural Network (SRL-RNN), which fuses them into a synergistic learning framework. Specifically, SRL-RNN applies an off-policy actor-critic framework to handle complex relations among multiple medications, diseases and individual characteristics. The "actor'' in the framework is adjusted by both the indicator signal and evaluation signal to ensure effective prescription and low mortality. RNN is further utilized to solve the Partially-Observed Markov Decision Process (POMDP) problem due to lack of fully observed states in real world applications. Experiments on the publicly real-world dataset, i.e., MIMIC-3, illustrate that our model can reduce the estimated mortality, while providing promising accuracy in matching doctors' prescriptions. In the model-based policy search approach to reinforcement learning (RL), policies are found using a model (or "simulator") of the Markov decision process. However, for high-dimensional continuous-state tasks, it can be extremely difficult to build an accurate model, and thus often the algorithm returns a policy that works in simulation but not in real-life. The other extreme, model-free RL, tends to require infeasibly large numbers of real-life trials. In this paper, we present a hybrid algorithm that requires only an approximate model, and only a small number of real-life trials. The key idea is to successively "ground" the policy evaluations using real-life trials, but to rely on the approximate model to suggest local changes. Our theoretical results show that this algorithm achieves near-optimal performance in the real system, even when the model is only approximate. Empirical results also demonstrate that---when given only a crude model and a small number of real-life trials---our algorithm can obtain near-optimal performance in the real system. We consider the problem of imitation learning where the examples, demonstrated by an expert, cover only a small part of a large state space. Inverse Reinforcement Learning (IRL) provides an ecient tool for generalizing the demonstration, based on the assumption that the expert is optimally acting in a Markov Decision Process (MDP). Most of the past work on IRL requires that a (near)optimal policy can be computed for dierent reward functions. However, this requirement can hardly be satised in systems with a large, or continuous, state space. In this paper, we propose a model-free IRL algorithm, where the relative entropy between the empirical distribution of the state-action trajectories under a baseline policy and their distribution under the learned policy is minimized by stochastic gradient descent. We compare this new approach to well-known IRL algorithms using learned MDP models. Empirical results on simulated car racing, gridworld and ball-in-a-cup problems show that our approach is able to learn good policies from a small number of demonstrations.