Learning a patient world model for health system simulation in intensive care

Abstract

Designing healthcare strategies requires anticipating their clinical and operational consequences before implementation, a task that often relies on health system simulation. Such a simulation necessitates modeling how patient states evolve and generate care demands. However, conventional approaches typically tailor compact state transitions to a single policy question and omit history-dependent dynamics, thus requiring the redefinition of states and transitions when there is a new question that entails different clinical information. We propose to learn a patient world model from longitudinal EHRs using a neural network to provide a shared clinical representation of patient trajectories that can serve simulation questions across scenarios. Taking ICU operations as an example, we train the model on MIMIC-IV, freeze it, and couple its time-queryable predictions to shared ICU calendars, resources, and queues via scenario-specific mappings, so that one model renders admission demand, care tasks, and discharge proposals across simulations evaluating ICU bed capacity, care dispatch, and post-ICU transfer capacity. Experiments show that our model matches Markov and semi-Markov comparators in aggregate occupancy and directional responses to capacity and dispatch policies. It also reproduces policy gains from replayed observed trajectories. For patients entering the same support state from different prior trajectories, the learned representation captures a 24-h recovery difference (-6.4 predicted versus -6.7 observed percentage points), a contrast missed by compact state models, which propagates into distinct simulated care demand, queue burden, and bed use. These results indicate that a learned world model of patient dynamics has the potential to replace question-specific state models, allowing new care policies to be evaluated by reconfiguring the scenario without model rebuilding.