A Patient World Model for Early Forecasting of Digital Health Campaign Outcomes: Capabilities and Limits

Abstract

Digital direct-to-consumer (DTC) health campaigns are usually measured after the fact. In-flight forecasting commonly relies on a separate classifier for every cutoff and horizon. We treat this task as a dynamic-system problem and build a compact patient world model. The architecture maintains a latent state per patient, learns exposure-conditioned state dynamics jointly with a weekly conversion hazard, and rolls forward into future conversion curves. We evaluate it on a US campaign dataset with 147{,}173 patients and 5.2 million at-risk person-weeks. In a retrospective evaluation conditioned on recorded future exposures, the model forecasts the remaining new-to-brand prescription volume through week 52 with a relative error of 2.9\% from a week-4 cutoff and 0.8--2.6\% from cutoffs at weeks 8--26. The strongest non-recurrent baseline, a pooled-hazard gradient boosting model given the same survival rollout and information, has relative errors of 13.6--33.1\%. Per-horizon classifiers perform substantially worse. A Fisher-information analysis motivates dense next-exposure supervision when conversions are rare. Removing this auxiliary objective increases prescription-volume error by approximately $2$--$14\times$, while providing no consistent disadvantage on the more common specialist-visit outcome. We also evaluate scenario simulation. Switching all future exposure off raises predicted conversion from 0.31 to 0.89, a pattern consistent with selection effects in observational exposure data. This result highlights the limits of interpreting exposure-conditioned rollouts causally.