arXiv subjects

Jean Feng

Publications and source records attributed to Jean Feng.

At least 19 recordsLinked to original sources

arXiv2026

Expert-Guided g-computation with Large Language Models for Estimating Causal Effects on Timings: Applications to Hospital Quality Improvement

Hospital quality improvement (QI) programs routinely face multiple candidate interventions to optimize hospital flow, but existing methods struggle to estimate and rank the causal effects of such interventions. This work focuses on one of the most standard hospital metrics, the average length of stay (LOS), and its causal estimand, the average time saved. To characterize this causal effect, qualitative approaches rely on expert judgment to map patient trajectories, making them susceptible to cognitive biases; quantitative approaches rely on data-driven models, which fail when interventions are hypothetical with no historical data or have complex causal mechanisms that require clinical reasoning rather than data alone. We propose expert-guided g-computation, or egg-computation, which combines the complementary strengths of both approaches by connecting the Gantt charts commonly used to map patient trajectories with the causal DAG literature. We introduce a causal model over Gantt charts and establish identification using a variant of g-computation that seeks expert input only for components unidentifiable from data. To make egg-computation practical, we develop an LLM-assisted pipeline that reliably scales up expert reasoning. In simulations, egg-computation outperforms conventional causal inference methods when patients have diverse causal structures and intervention mechanisms. In a study of eleven candidate QI interventions at an urban safety-net hospital, the LLM pipeline generated graphs and time-saving estimates highly concordant with those of human experts. Beyond healthcare, egg-computation is a broadly applicable framework for estimating the average time saved for candidate interventions whose causal mechanisms can be represented using Gantt charts.

stat.ME↗

arXiv2026

Expert Evaluation of Clinical AI Tools on Real Point-of-Care Clinical Queries

Physicians now pose millions of clinical questions to AI tools each week, yet these tools are evaluated largely on hypothetical or exam-style questions, not those actually asked in practice. We report a blinded evaluation built on 620 Real-world Point-Of-Care Queries (Real-POCQi) submitted to the OpenEvidence (OE) platform by physicians spanning 30 specialties, as well as 187 questions from HealthBench. 149 practicing physicians across 36 states made head-to-head comparisons between answers from three frontier general-purpose models (Claude Opus 4.8, Gemini 3.1 Pro, and GPT-5.5) and a specialized clinical tool (OE), with graders matched to each question's specialty. When comparing answers along five dimensions relevant to clinical decision support -- accuracy, clinical utility, source quality, verifiability, & completeness -- physicians scored the specialized tool highest on all axes; in the primary analysis on Real-POCQi, win differences (margins between win and loss rates) ranged from 25 to 39 percentage points (p<0.001). Results remained consistent in sensitivity analyses stratifying by citation display, answer length, OE-user status, and Real-POCQi versus HealthBench. In parallel, LLM judges were found to systematically differ from expert judges, though both generally agreed on the best model. These findings underscore two conclusions: (i) AI tool evaluations should reflect real-world query distributions and use expert judges that mirror the specialization defining modern medicine and (ii) the consistent advantage of the specialized tool over general-purpose models does not necessarily mean that the latter cannot serve similar purposes, but that targeted engineering and customization can yield meaningful gains in performance for its users. We release Real-POCQi as a public benchmark, as well as the prespecified statistical analysis for reproducing results of this study.

cs.AI↗

arXiv2026

Adaptive auditing of AI systems with anytime-valid guarantees

A major bottleneck in characterizing the failure modes of generative AI systems is the cost and time of annotation and evaluation. Consequently, adaptive testing paradigms have gained popularity, where one opportunistically decides which cases and how many to annotate based on past results. While this framework is highly practical, its extreme flexibility makes it difficult to draw statistically rigorous conclusions, as it violates classical assumptions: the number of observations is typically limited (often 10 to 50 cases) and decisions regarding sampling and stopping are made in the midst of data collection rather than based a pre-specified rule. To characterize what statistical inferences can be drawn from highly adaptive audits, we introduce a hypothesis testing framework from two 'dueling' perspectives: (i) the model's null that asserts there is no failure mode with performance below a target threshold versus (ii) the auditor's null that asserts they have a sampling strategy that will uncover a failure mode. Leveraging Safe Anytime-Valid Inference (SAVI), we formalize the auditor as conducting 'testing by betting', which translates into simultaneous e-processes for testing the dueling null hypotheses. Furthermore, if the auditor is sufficiently powerful, we prove that these two hypotheses are asymptotically inverses of each other, in that passage of a stringent audit does in fact certify the AI system as being globally robust. Empirically, we demonstrate that our proposed testing procedures maintain anytime-valid type-I error control, outperform pre-specified testing methods, and can reach statistically rigorous conclusions sometimes with as few as 20 observations.

cs.AI↗

arXiv2026

From Fuzzy to Formal: Scaling Hospital Quality Improvement with AI

Hospital Quality Improvement (QI) plays a critical role in optimizing healthcare delivery by translating high-level hospital goals into actionable solutions. A critical step of QI is to identify the key modifiable contributing factors, a process we call QI factor discovery, typically through expert-driven semi-structured qualitative tools like fishbone diagrams, chart reviews, and Lean Healthcare methods. AI has the potential to transform and accelerate QI factor discovery, which is traditionally time- and resource-intensive and limited in reproducibility and auditability. Nevertheless, current AI alignment methods assume the task is well-defined, whereas QI factor discovery is an exploratory, fuzzy, and iterative sense-making process that relies on complex implicit expert judgments. To design an AI pipeline that formalizes the QI process while preserving its exploratory components, we propose viewing the task as learning not only LLM prompts but also the overarching natural-language specifications. In particular, we map QI factor discovery to steps of the classical AI/ML development process (problem formalization, model learning, and model validation) where the specifications are tunable hyperparameters. Domain experts and AI agents iteratively refine both the overarching specifications and AI pipeline until AI extractions are concordant with expert annotations and aligned with clinical objectives. We applied this "Human-AI Spec-Solution Co-optimization" framework at an urban safety-net hospital to identify factors driving prolonged length of stay and unplanned 30-day readmissions. The resulting AI-for-QI pipelines achieved $\ge 70\%$ concordance with expert annotations. Compared to prior manual Lean analyses, the AI pipeline was substantially more efficient, recovered previous findings, surfaced new modifiable factors, and produced auditable reasoning traces.

cs.AI↗

arXiv2026

More Than "Means to an End": Supporting Reasoning with Transparently Designed AI Data Science Processes

Generative artificial intelligence (AI) tools can now help people perform complex data science tasks regardless of their expertise. While these tools have great potential to help more people work with data, their end-to-end approach does not support users in evaluating alternative approaches and reformulating problems, both critical to solving open-ended tasks in high-stakes domains. In this paper, we reflect on two AI data science systems designed for the medical setting and how they function as tools for thought. We find that success in these systems was driven by constructing AI workflows around intentionally-designed intermediate artifacts, such as readable query languages, concept definitions, or input-output examples. Despite opaqueness in other parts of the AI process, these intermediates helped users reason about important analytical choices, refine their initial questions, and contribute their unique knowledge. We invite the HCI community to consider when and how intermediate artifacts should be designed to promote effective data science thinking.

cs.HC↗

arXiv2026

Human-AI Co-design for Clinical Prediction Models

Developing safe, effective, and practically useful clinical prediction models (CPMs) traditionally requires iterative collaboration between clinical experts, data scientists, and informaticists. This process refines the often small but critical details of the model building process, such as which features/patients to include and how clinical categories should be defined. However, this traditional collaboration process is extremely time- and resource-intensive, resulting in only a small fraction of CPMs reaching clinical practice. This challenge intensifies when teams attempt to incorporate unstructured clinical notes, which can contain an enormous number of concepts. To address this challenge, we introduce HACHI, an iterative human-in-the-loop framework that uses AI agents to accelerate the development of fully interpretable CPMs by enabling the exploration of concepts in clinical notes. HACHI alternates between (i) an AI agent rapidly exploring and evaluating candidate concepts in clinical notes and (ii) clinical and domain experts providing feedback to improve the CPM learning process. HACHI defines concepts as simple yes-no questions that are used in linear models, allowing the clinical AI team to transparently review, refine, and validate the CPM learned in each round. In two real-world prediction tasks (acute kidney injury and traumatic brain injury), HACHI outperforms existing approaches, surfaces new clinically relevant concepts not included in commonly-used CPMs, and improves model generalizability across clinical sites and time periods. Furthermore, HACHI reveals the critical role of the clinical AI team, such as directing the AI agent to explore concepts that it had not previously considered, adjusting the granularity of concepts it considers, changing the objective function to better align with the clinical objectives, and identifying issues of data bias and leakage.

cs.AI↗

arXiv2025

Reflections from Research Roundtables at the Conference on Health, Inference, and Learning (CHIL) 2025

The 6th Annual Conference on Health, Inference, and Learning (CHIL 2025), hosted by the Association for Health Learning and Inference (AHLI), was held in person on June 25-27, 2025, at the University of California, Berkeley, in Berkeley, California, USA. As part of this year's program, we hosted Research Roundtables to catalyze collaborative, small-group dialogue around critical, timely topics at the intersection of machine learning and healthcare. Each roundtable was moderated by a team of senior and junior chairs who fostered open exchange, intellectual curiosity, and inclusive engagement. The sessions emphasized rigorous discussion of key challenges, exploration of emerging opportunities, and collective ideation toward actionable directions in the field. In total, eight roundtables were held by 19 roundtable chairs on topics of "Explainability, Interpretability, and Transparency," "Uncertainty, Bias, and Fairness," "Causality," "Domain Adaptation," "Foundation Models," "Learning from Small Medical Data," "Multimodal Methods," and "Scalable, Translational Healthcare Solutions."

cs.LG↗

arXiv2025

Realistic CDSS Drug Dosing with End-to-end Recurrent Q-learning for Dual Vasopressor Control

Reinforcement learning (RL) applications in Clinical Decision Support Systems (CDSS) frequently encounter skepticism because models may recommend inoperable dosing decisions. We propose an end-to-end offline RL framework for dual vasopressor administration in Intensive Care Units (ICUs) that directly addresses this challenge through principled action space design. Our method integrates discrete, continuous, and directional dosing strategies with conservative Q-learning and incorporates a novel recurrent modeling using a replay buffer to capture temporal dependencies in ICU time-series data. Our comparative analysis of norepinephrine dosing strategies across different action space formulations reveals that the designed action spaces improve interpretability and facilitate clinical adoption while preserving efficacy. Empirical results on eICU and MIMIC demonstrate that action space design profoundly influences learned behavioral policies. Compared with baselines, the proposed methods achieve more than 3x expected reward improvements, while aligning with established clinical protocols.

cs.LG↗

arXiv2025

When the Domain Expert Has No Time and the LLM Developer Has No Clinical Expertise: Real-World Lessons from LLM Co-Design in a Safety-Net Hospital

Large language models (LLMs) have the potential to address social and behavioral determinants of health by transforming labor intensive workflows in resource-constrained settings. Creating LLM-based applications that serve the needs of underserved communities requires a deep understanding of their local context, but it is often the case that neither LLMs nor their developers possess this local expertise, and the experts in these communities often face severe time/resource constraints. This creates a disconnect: how can one engage in meaningful co-design of an LLM-based application for an under-resourced community when the communication channel between the LLM developer and domain expert is constrained? We explored this question through a real-world case study, in which our data science team sought to partner with social workers at a safety net hospital to build an LLM application that summarizes patients' social needs. Whereas prior works focus on the challenge of prompt tuning, we found that the most critical challenge in this setting is the careful and precise specification of \what information to surface to providers so that the LLM application is accurate, comprehensive, and verifiable. Here we present a novel co-design framework for settings with limited access to domain experts, in which the summary generation task is first decomposed into individually-optimizable attributes and then each attribute is efficiently refined and validated through a multi-tier cascading approach.

cs.CY↗

arXiv2025

"Who experiences large model decay and why?" A Hierarchical Framework for Diagnosing Heterogeneous Performance Drift

Machine learning (ML) models frequently experience performance degradation when deployed in new contexts. Such degradation is rarely uniform: some subgroups may suffer large performance decay while others may not. Understanding where and how large differences in performance arise is critical for designing targeted corrective actions that mitigate decay for the most affected subgroups while minimizing any unintended effects. Current approaches do not provide such detailed insight, as they either (i) explain how average performance shifts arise or (ii) identify adversely affected subgroups without insight into how this occurred. To this end, we introduce a Subgroup-scanning Hierarchical Inference Framework for performance drifT (SHIFT). SHIFT first asks "Is there any subgroup with unacceptably large performance decay due to covariate/outcome shifts?" (Where?) and, if so, dives deeper to ask "Can we explain this using more detailed variable(subset)-specific shifts?" (How?). In real-world experiments, we find that SHIFT identifies interpretable subgroups affected by performance decay, and suggests targeted actions that effectively mitigate the decay.

cs.LG↗

arXiv2025

LLMs Judging LLMs: A Simplex Perspective

Given the challenge of automatically evaluating free-form outputs from large language models (LLMs), an increasingly common solution is to use LLMs themselves as the judging mechanism, without any gold-standard scores. Implicitly, this practice accounts for only sampling variability (aleatoric uncertainty) and ignores uncertainty about judge quality (epistemic uncertainty). While this is justified if judges are perfectly accurate, it is unclear when such an approach is theoretically valid and practically robust. We study these questions for the task of ranking LLM candidates from a novel geometric perspective: for $M$-level scoring systems, both LLM judges and candidates can be represented as points on an $(M-1)$-dimensional probability simplex, where geometric concepts (e.g., triangle areas) correspond to key ranking concepts. This perspective yields intuitive theoretical conditions and visual proofs for when rankings are identifiable; for instance, we provide a formal basis for the ``folk wisdom'' that LLM judges are more effective for two-level scoring ($M=2$) than multi-level scoring ($M>2$). Leveraging the simplex, we design geometric Bayesian priors that encode epistemic uncertainty about judge quality and vary the priors to conduct sensitivity analyses. Experiments on LLM benchmarks show that rankings based solely on LLM judges are robust in many but not all datasets, underscoring both their widespread success and the need for caution. Our Bayesian method achieves substantially higher coverage rates than existing procedures, highlighting the importance of modeling epistemic uncertainty.

cs.LG↗

arXiv2024

Bayesian Concept Bottleneck Models with LLM Priors

Concept Bottleneck Models (CBMs) have been proposed as a compromise between white-box and black-box models, aiming to achieve interpretability without sacrificing accuracy. The standard training procedure for CBMs is to predefine a candidate set of human-interpretable concepts, extract their values from the training data, and identify a sparse subset as inputs to a transparent prediction model. However, such approaches are often hampered by the tradeoff between exploring a sufficiently large set of concepts versus controlling the cost of obtaining concept extractions, resulting in a large interpretability-accuracy tradeoff. This work investigates a novel approach that sidesteps these challenges: BC-LLM iteratively searches over a potentially infinite set of concepts within a Bayesian framework, in which Large Language Models (LLMs) serve as both a concept extraction mechanism and prior. Even though LLMs can be miscalibrated and hallucinate, we prove that BC-LLM can provide rigorous statistical inference and uncertainty quantification. Across image, text, and tabular datasets, BC-LLM outperforms interpretable baselines and even black-box models in certain settings, converges more rapidly towards relevant concepts, and is more robust to out-of-distribution samples.

cs.LG↗

arXiv2024

A hierarchical decomposition for explaining ML performance discrepancies

Machine learning (ML) algorithms can often differ in performance across domains. Understanding $\textit{why}$ their performance differs is crucial for determining what types of interventions (e.g., algorithmic or operational) are most effective at closing the performance gaps. Existing methods focus on $\textit{aggregate decompositions}$ of the total performance gap into the impact of a shift in the distribution of features $p(X)$ versus the impact of a shift in the conditional distribution of the outcome $p(Y|X)$; however, such coarse explanations offer only a few options for how one can close the performance gap. $\textit{Detailed variable-level decompositions}$ that quantify the importance of each variable to each term in the aggregate decomposition can provide a much deeper understanding and suggest much more targeted interventions. However, existing methods assume knowledge of the full causal graph or make strong parametric assumptions. We introduce a nonparametric hierarchical framework that provides both aggregate and detailed decompositions for explaining why the performance of an ML algorithm differs across domains, without requiring causal knowledge. We derive debiased, computationally-efficient estimators, and statistical inference procedures for asymptotically valid confidence intervals.

cs.LG↗

arXiv2023

A Brief Tutorial on Sample Size Calculations for Fairness Audits

In fairness audits, a standard objective is to detect whether a given algorithm performs substantially differently between subgroups. Properly powering the statistical analysis of such audits is crucial for obtaining informative fairness assessments, as it ensures a high probability of detecting unfairness when it exists. However, limited guidance is available on the amount of data necessary for a fairness audit, lacking directly applicable results concerning commonly used fairness metrics. Additionally, the consideration of unequal subgroup sample sizes is also missing. In this tutorial, we address these issues by providing guidance on how to determine the required subgroup sample sizes to maximize the statistical power of hypothesis tests for detecting unfairness. Our findings are applicable to audits of binary classification models and multiple fairness metrics derived as summaries of the confusion matrix. Furthermore, we discuss other aspects of audit study designs that can increase the reliability of audit results.

stat.AP↗

arXiv2023

Designing monitoring strategies for deployed machine learning algorithms: navigating performativity through a causal lens

After a machine learning (ML)-based system is deployed, monitoring its performance is important to ensure the safety and effectiveness of the algorithm over time. When an ML algorithm interacts with its environment, the algorithm can affect the data-generating mechanism and be a major source of bias when evaluating its standalone performance, an issue known as performativity. Although prior work has shown how to validate models in the presence of performativity using causal inference techniques, there has been little work on how to monitor models in the presence of performativity. Unlike the setting of model validation, there is much less agreement on which performance metrics to monitor. Different monitoring criteria impact how interpretable the resulting test statistic is, what assumptions are needed for identifiability, and the speed of detection. When this choice is further coupled with the decision to use observational versus interventional data, ML deployment teams are faced with a multitude of monitoring options. The aim of this work is to highlight the relatively under-appreciated complexity of designing a monitoring strategy and how causal reasoning can provide a systematic framework for choosing between these options. As a motivating example, we consider an ML-based risk prediction algorithm for predicting unplanned readmissions. Bringing together tools from causal inference and statistical process control, we consider six monitoring procedures (three candidate monitoring criteria and two data sources) and investigate their operating characteristics in simulation studies. Results from this case study emphasize the seemingly simple (and obvious) fact that not all monitoring systems are created equal, which has real-world impacts on the design and documentation of ML monitoring systems.

cs.LG↗

arXiv2023

Is this model reliable for everyone? Testing for strong calibration

In a well-calibrated risk prediction model, the average predicted probability is close to the true event rate for any given subgroup. Such models are reliable across heterogeneous populations and satisfy strong notions of algorithmic fairness. However, the task of auditing a model for strong calibration is well-known to be difficult -- particularly for machine learning (ML) algorithms -- due to the sheer number of potential subgroups. As such, common practice is to only assess calibration with respect to a few predefined subgroups. Recent developments in goodness-of-fit testing offer potential solutions but are not designed for settings with weak signal or where the poorly calibrated subgroup is small, as they either overly subdivide the data or fail to divide the data at all. We introduce a new testing procedure based on the following insight: if we can reorder observations by their expected residuals, there should be a change in the association between the predicted and observed residuals along this sequence if a poorly calibrated subgroup exists. This lets us reframe the problem of calibration testing into one of changepoint detection, for which powerful methods already exist. We begin with introducing a sample-splitting procedure where a portion of the data is used to train a suite of candidate models for predicting the residual, and the remaining data are used to perform a score-based cumulative sum (CUSUM) test. To further improve power, we then extend this adaptive CUSUM test to incorporate cross-validation, while maintaining Type I error control under minimal assumptions. Compared to existing methods, the proposed procedure consistently achieved higher power in simulation studies and more than doubled the power when auditing a mortality risk prediction model.

cs.LG↗

arXiv2022

Monitoring machine learning (ML)-based risk prediction algorithms in the presence of confounding medical interventions

Performance monitoring of machine learning (ML)-based risk prediction models in healthcare is complicated by the issue of confounding medical interventions (CMI): when an algorithm predicts a patient to be at high risk for an adverse event, clinicians are more likely to administer prophylactic treatment and alter the very target that the algorithm aims to predict. A simple approach is to ignore CMI and monitor only the untreated patients, whose outcomes remain unaltered. In general, ignoring CMI may inflate Type I error because (i) untreated patients disproportionally represent those with low predicted risk and (ii) evolution in both the model and clinician trust in the model can induce complex dependencies that violate standard assumptions. Nevertheless, we show that valid inference is still possible if one monitors conditional performance and if either conditional exchangeability or time-constant selection bias hold. Specifically, we develop a new score-based cumulative sum (CUSUM) monitoring procedure with dynamic control limits. Through simulations, we demonstrate the benefits of combining model updating with monitoring and investigate how over-trust in a prediction model may delay detection of performance deterioration. Finally, we illustrate how these monitoring methods can be used to detect calibration decay of an ML-based risk calculator for postoperative nausea and vomiting during the COVID-19 pandemic.

stat.ML↗

arXiv2022

Sequential algorithmic modification with test data reuse

After initial release of a machine learning algorithm, the model can be fine-tuned by retraining on subsequently gathered data, adding newly discovered features, or more. Each modification introduces a risk of deteriorating performance and must be validated on a test dataset. It may not always be practical to assemble a new dataset for testing each modification, especially when most modifications are minor or are implemented in rapid succession. Recent works have shown how one can repeatedly test modifications on the same dataset and protect against overfitting by (i) discretizing test results along a grid and (ii) applying a Bonferroni correction to adjust for the total number of modifications considered by an adaptive developer. However, the standard Bonferroni correction is overly conservative when most modifications are beneficial and/or highly correlated. This work investigates more powerful approaches using alpha-recycling and sequentially-rejective graphical procedures (SRGPs). We introduce novel extensions that account for correlation between adaptively chosen algorithmic modifications. In empirical analyses, the SRGPs control the error rate of approving unacceptable modifications and approve a substantially higher number of beneficial modifications than previous approaches.

stat.ML↗