Triage Score: A Counterfactual Risk Assessment Instrument

Abstract

Risk assessment instruments, also known as "risk scores," are widely used in high-stakes decision-making settings such as medicine and the criminal justice system. A risk score predicts the likelihood of an undesired outcome if no intervention is made. Thus, a sufficiently high score is often interpreted as a recommendation to intervene. However, risk scores fail to account for what would happen if a decision-maker does intervene. This failure is problematic because effective decision making requires consideration of both or multiple potential outcomes. We propose "triage scores," which are based on additive counterfactual utilities and include risk scores as a special case. Unlike risk scores, triage scores can incorporate counterfactual outcomes under alternative decisions, enabling decision makers to incorporate a wide range of ethical and practical factors. We illustrate the use of triage scores with an application to our own randomized controlled trial evaluating a pretrial risk score. Our analysis demonstrates that triage scores are able to capture rich utility structures and yield substantively distinct results regarding policy evaluation and learning.