arXiv subjects

Jitao Wang

Publications and source records attributed to Jitao Wang.

8 recordsLinked to original sources

arXiv2026

A Distribution Mapping Approach to Counterfactually Fair Reinforcement Learning

Reinforcement learning (RL) seeks to optimize sequential decisions to maximize population-level benefits over time. However, when deployed in high-stakes settings such as healthcare, RL decisions might systematically restrict some subpopulation's access to valuable services in a manner contrary to the values and goals of stakeholders. Counterfactual fairness (CF) offers a promising framework to address this problem based on causal reasoning. This paper develops a data preprocessing algorithm that, when used in tandem with policy learning, enables CF in RL. Our algorithm relies on a novel quantile distribution mapping method for sequentially estimating the counterfactual states and rewards in the data preprocessing step, subsuming common additivity assumptions used for counterfactual prediction as a special case. We theoretically prove that the per-step level of counterfactual unfairness and infinite-horizon suboptimality gap can be bounded under mild regularity conditions. We also empirically test our algorithm in numerical experiments as well as in application to a real-world interventional digital health dataset.

stat.ML↗

arXiv2026

ClinFusion: A Vision-Centric Multimodal LLM System for Holistic Medical Understanding

Multimodal large language models (MLLMs) hold immense potential to revolutionize clinical practice, yet deploying them in the medical domain is fundamentally a vision-centric challenge: models must absorb knowledge from heterogeneous 2D and 3D medical images, and evaluation protocols must align with radiologists' clinical practice and provide an accurate, fine-grained and factualness-driven assessment. In this paper, we introduce ClinFusion, a vision-centric MLLM designed for holistic medical understanding that systematically addresses these limitations. We propose a compositional and cascaded vision encoder architecture featuring a Cascade Spatial-Aware Locality Fusion operator that unifies diverse 2D and native 3D medical image understanding within a fused encoder. We further introduce a vision-grounded evaluation framework, including MedIF-Bench for instruction-following assessment and a region-of-interest-grounded method for clinically aligned and factualness-driven report generation evaluation. We show that ClinFusion sets a new state-of-the-art across a comprehensive suite of 2D and 3D multimodal medical benchmarks---spanning visual question answering, report generation, and instruction following---as well as textual medical tasks, outperforming leading open-source medical MLLMs (\textit{e.g.}, Hulu-Med, Lingshu) on 20 out of 24 benchmarks and demonstrating multimodal capabilities better than powerful proprietary models such as GPT-5.2 and Gemini-3-Flash on 13 out of 16 benchmarks, and can be further augmented with agentic tool use for retrieval-augmented and tool-assisted clinical workflows. A blinded evaluation by board-certified radiologists confirms that ClinFusion produces the highest-ranked reports, and validates our RoI-grounded metric as achieving the strongest correlation with expert judgment among all automatic evaluation metrics examined.

cs.CV↗

arXiv2026

Towards Precision Therapy in Hepatocellular Carcinoma: A Clinical-Reasoning LLM for Risk Stratification and Treatment Guidance

Hepatocellular carcinoma (HCC) is a common malignancy and a leading cause of cancer-related mortality. Current guidelines and staging systems provide coarse categories, but often miss within-stage heterogeneity and the clinical context in electronic medical records (EMRs). We present HCC-STAR (Hepatocellular Carcinoma Staging, Treatment And pRognosis), a clinically aligned large language model that reads routine EMR narratives and jointly outputs risk score-based staging, ranked guideline-consistent treatments with evidence-based rationales, and individualized survival estimates. We curated about 30,000 HCC cases from SEER and expanded them into EMR-style narrative training data using a clinician-validated, prompt-based augmentation workflow. On this corpus, we developed a knowledge-aligned reasoning framework optimized with a step-verifiable composite reward, moving beyond text-level memorization of clinical guidelines. In a multi-center cohort of 6,668 patients from 12 hospitals in China, HCC-STAR achieved state-of-the-art performance in treatment recommendation and risk stratification compared with clinical guidelines and competitive models, including GPT-5 and Gemini-2.5 Pro. Hypothetical overall-survival analysis showed a median survival of 51 months under adherence to HCC-STAR recommendations, compared with 29 and 32 months under BCLC and CNLC. In clinician-centric evaluations, blinded hepatobiliary specialists rated HCC-STAR's reasoning and evidence-based justifications as trustworthy. The model surpassed resident and attending physicians in treatment accuracy and helped physicians make more accurate decisions faster when used as an assistant. These findings support HCC-STAR as a reliable and verifiable decision-support system for risk stratification and precision therapy in HCC.

cs.AI↗

arXiv2025

PyCFRL: A Python library for counterfactually fair offline reinforcement learning via sequential data preprocessing

Reinforcement learning (RL) aims to learn and evaluate a sequential decision rule, often referred to as a "policy", that maximizes the population-level benefit in an environment across possibly infinitely many time steps. However, the sequential decisions made by an RL algorithm, while optimized to maximize overall population benefits, may disadvantage certain individuals who are in minority or socioeconomically disadvantaged groups. To address this problem, we introduce PyCFRL, a Python library for ensuring counterfactual fairness in offline RL. PyCFRL implements a novel data preprocessing algorithm for learning counterfactually fair RL policies from offline datasets and provides tools to evaluate the values and counterfactual unfairness levels of RL policies. We describe the high-level functionalities of PyCFRL and demonstrate one of its major use cases through a data example. The library is publicly available on PyPI and Github (https://github.com/JianhanZhang/PyCFRL), and detailed tutorials can be found in the PyCFRL documentation (https://pycfrl-documentation.netlify.app).

stat.ML↗

arXiv2025

Generalized Fitted Q-Iteration with Clustered Data

This paper focuses on reinforcement learning (RL) with clustered data, which is commonly encountered in healthcare applications. We propose a generalized fitted Q-iteration (FQI) algorithm that incorporates generalized estimating equations into policy learning to handle the intra-cluster correlations. Theoretically, we demonstrate (i) the optimalities of our Q-function and policy estimators when the correlation structure is correctly specified, and (ii) their consistencies when the structure is mis-specified. Empirically, through simulations and analyses of a mobile health dataset, we find the proposed generalized FQI achieves, on average, a half reduction in regret compared to the standard FQI.

cs.LG↗

arXiv2025

Multivariate Dynamic Mediation Analysis under a Reinforcement Learning Framework

Mediation analysis is an important analytic tool commonly used in a broad range of scientific applications. In this article, we study the problem of mediation analysis when there are multivariate and conditionally dependent mediators, and when the variables are observed over multiple time points. The problem is challenging, because the effect of a mediator involves not only the path from the treatment to this mediator itself at the current time point, but also all possible paths pointed to this mediator from its upstream mediators, as well as the carryover effects from all previous time points. We propose a novel multivariate dynamic mediation analysis approach. Drawing inspiration from the Markov decision process model that is frequently employed in reinforcement learning, we introduce a Markov mediation process paired with a system of time-varying linear structural equation models to formulate the problem. We then formally define the individual mediation effect, built upon the idea of simultaneous interventions and intervention calculus. We next derive the closed-form expression and propose an iterative estimation procedure under the Markov mediation process model. We study both the asymptotic property and the empirical performance of the proposed estimator, and further illustrate our method with a mobile health application.

stat.ME↗

arXiv2025

Counterfactually Fair Reinforcement Learning via Sequential Data Preprocessing

When applied in healthcare, reinforcement learning (RL) seeks to dynamically match the right interventions to subjects to maximize population benefit. However, the learned policy may disproportionately allocate efficacious actions to one subpopulation, creating or exacerbating disparities in other socioeconomically-disadvantaged subgroups. These biases tend to occur in multi-stage decision making and can be self-perpetuating, which if unaccounted for could cause serious unintended consequences that limit access to care or treatment benefit. Counterfactual fairness (CF) offers a promising statistical tool grounded in causal inference to formulate and study fairness. In this paper, we propose a general framework for fair sequential decision making. We theoretically characterize the optimal CF policy and prove its stationarity, which greatly simplifies the search for optimal CF policies by leveraging existing RL algorithms. The theory also motivates a sequential data preprocessing algorithm to achieve CF decision making under an additive noise assumption. We prove and then validate our policy learning approach in controlling unfairness and attaining optimal value through simulations. Analysis of a digital health dataset designed to reduce opioid misuse shows that our proposal greatly enhances fair access to counseling.

stat.ML↗

arXiv2023

A Reinforcement Learning Framework for Dynamic Mediation Analysis

Mediation analysis learns the causal effect transmitted via mediator variables between treatments and outcomes and receives increasing attention in various scientific domains to elucidate causal relations. Most existing works focus on point-exposure studies where each subject only receives one treatment at a single time point. However, there are a number of applications (e.g., mobile health) where the treatments are sequentially assigned over time and the dynamic mediation effects are of primary interest. Proposing a reinforcement learning (RL) framework, we are the first to evaluate dynamic mediation effects in settings with infinite horizons. We decompose the average treatment effect into an immediate direct effect, an immediate mediation effect, a delayed direct effect, and a delayed mediation effect. Upon the identification of each effect component, we further develop robust and semi-parametrically efficient estimators under the RL framework to infer these causal effects. The superior performance of the proposed method is demonstrated through extensive numerical studies, theoretical results, and an analysis of a mobile health dataset.

stat.ML↗