# Healthcare applications of 0-1 neural networks in prescriptive problems with observational data

## TL;DR

This paper introduces prescriptive neural networks (PNNs) to improve treatment decisions in healthcare using limited observational data.

## Contribution

PNNs are shallow 0-1 neural networks trained with mixed integer programming for interpretable and effective policy optimization.

## Key findings

- PNNs reduced peak blood pressure by 5.47 mm Hg compared to existing clinical practice.
- PNNs outperformed other models by 2 mm Hg in blood pressure reduction.
- PNNs identified clinically significant features while avoiding biased ones like race or insurance.

## Abstract

A key challenge in medical decision making is learning treatment policies for patients with limited observational data. This challenge is particularly evident in personalized healthcare decision-making, where models need to take into account the intricate relationships between patient characteristics, treatment options, and health outcomes. To address this, we introduce prescriptive neural networks (PNNs), shallow 0-1 neural networks trained with mixed integer programming that can be used with counterfactual estimation to optimize policies in medium data settings. These models offer greater interpretability than deep neural networks and can encode more complex policies than common models such as decision trees. We show that PNNs can outperform existing methods in both synthetic data experiments and in a case study of assigning treatments for postpartum hypertension. In particular, PNNs are shown to produce policies that could reduce peak blood pressure by 5.47 mm Hg (p=0.02) over existing clinical practice, and by 2 mm Hg (p=0.01) over the next best prescriptive modeling technique. Moreover PNNs were more likely than all other models to correctly identify clinically significant features while existing models relied on potentially dangerous features such as patient insurance information and race that could lead to bias in treatment.