Unveiling Bias in Sequential Decision Making: A Causal Inference Approach for Stochastic Service Systems

TL;DR

This paper develops a causal inference framework to identify and quantify sequential bias in decision-making within stochastic service systems, using marked point processes and applying it to emergency department data.

Contribution

It introduces a novel approach linking sequential bias to dynamic treatment regimes and extends causal inference methods to handle random decision counts.

Findings

Significant impact of routing decisions on future patient care.

Proposed estimators exhibit double robustness and efficiency.

Application to emergency department data demonstrates practical utility.

Abstract

In many stochastic service systems, decision-makers find themselves making a sequence of decisions, with the number of decisions being unpredictable. To enhance these decisions, it is crucial to uncover the causal impact these decisions have through careful analysis of observational data from the system. However, these decisions are not made independently, as they are shaped by previous decisions and outcomes. This phenomenon is called sequential bias and violates a key assumption in causal inference that one person's decision does not interfere with the potential outcomes of another. To address this issue, we establish a connection between sequential bias and the subfield of causal inference known as dynamic treatment regimes. We expand these frameworks to account for the random number of decisions by modeling the decision-making process as a marked point process. Consequently, we can define and identify causal effects to quantify sequential bias. Moreover, we propose estimators and explore their properties, including double robustness and semiparametric efficiency. In a case study of 27,831 encounters with a large academic emergency department, we use our approach to demonstrate that the decision to route a patient to an area for low acuity patients has a significant impact on the care of future patients.