Estimating Dynamic Treatment Regimes in Mobile Health Using V-learning

TL;DR

This paper introduces V-learning, a reinforcement learning approach for estimating personalized, dynamic treatment regimes in mobile health, capable of handling real-time, minute-by-minute decision making for chronic disease management.

Contribution

It develops a new method for estimating optimal dynamic treatment regimes suited for mobile health data with continuous decision points, extending existing approaches.

Findings

Method is consistent and asymptotically normal.

Applied to blood glucose control in type 1 diabetes patients.

Supports indefinite time horizons and high-frequency decision making.

Abstract

The vision for precision medicine is to use individual patient characteristics to inform a personalized treatment plan that leads to the best healthcare possible 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, 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 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.