Estimating Dynamic Treatment Regimes in Mobile Health Using V-Learning

2020
The vision for precision medicine is to use individual patient characteristics to inform a personalized treatment plan that leads to the best possible healthcare for each patient. Mobile technologies have an important role to play in this vision as they offer a means to monitor a patient's health status in real-time and subsequently to deliver interventions if, when, and in the dose that they are needed. Dynamic treatment regimes formalize individualized treatment plans as sequences of decision rules, one per stage of clinical intervention, that map current patient information to a recommended treatment. However, most existing methods for estimating optimal dynamic treatment regimes are designed for a small number of fixed decision points occurring on a coarse time-scale. We propose a new reinforcement learning method for estimating an optimal treatment regime that is applicable to data collected using mobile technologies in an outpatient setting. The proposed method accommodates an indefinite time horizon and minute-by-minute decision making that are common in mobile health applications. We show that the proposed estimators are consistent and asymptotically normal under mild conditions. The proposed methods are applied to estimate an optimal dynamic treatment regime for controlling blood glucose levels in patients with type 1 diabetes.
JOURNAL OF THE AMERICAN STATISTICAL ASSOCIATION
页码:692-706|卷号:115|期号:530
ISSN:0162-1459
收录类型
SSCI
发表日期
2020
学科领域
循证社会科学-方法
国家
美国
语种
英语
DOI
10.1080/01621459.2018.1537919
其他关键词
LOOP INSULIN DELIVERY; GLYCEMIC CONTROL; TYPE-1; ADOLESCENTS; SYSTEM; PREDICTORS; CHILDREN; DESIGN; MODELS; TRIALS
EISSN
1537-274X
资助机构
NIHUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [P01 CA142538, UL1 TR001111, T32 CA201159, R01 AA023187]; NSFNational Science Foundation (NSF) [DMS-1555141, DMS-1513579, DMS-1407732]
资助信息
The authors gratefully acknowledge NIH P01 CA142538, NIH UL1 TR001111, NIH T32 CA201159, NSF DMS-1555141, NSF DMS-1513579, NSF DMS-1407732, NIH R01 AA023187.
被引频次(WOS)
12
被引更新日期
2022-01
来源机构
University of North Carolina University of North Carolina Chapel Hill University of North Carolina North Carolina State University University of North Carolina University of North Carolina Chapel Hill Stanford University
关键词
Markov decision processes Precision medicine Reinforcement learning Type 1 diabetes