Harnessing Causality in Reinforcement Learning With Bagged Decision Times

We consider reinforcement learning (RL) for a class of problems with bagged decision times. A bag contains a finite sequence of consecutive decision times. The transition dynamics are non-Markovian and non-stationary within a bag. Further, all actions within a bag jointly impact a single reward, observed at the end of the bag. Our goal is to construct an online RL algorithm to maximize the discounted sum of the bag-specific rewards. To handle non-Markovian transitions within a bag, we utilize an expert-provided causal directed acyclic graph (DAG). Based on the DAG, we construct the states as a dynamical Bayesian sufficient statistic of the observed history, which results in Markovian state transitions within and across bags. We then frame this problem as a periodic Markov decision process (MDP) that allows non-stationarity within a period. An online RL algorithm based on Bellman-equations for stationary MDPs is generalized to handle periodic MDPs. To justify the proposed RL algorithm, we show that our constructed state achieves the maximal optimal value function among all state constructions for a periodic MDP. Further we prove the Bellman optimality equations for periodic MDPs. We evaluate the proposed method on testbed variants, constructed with real data from a mobile health clinical trial.

A Deployed Online Reinforcement Learning Algorithm In An Oral Health Clinical Trial

Dental disease is a prevalent chronic condition associated with substantial financial burden, personal suffering, and increased risk of systemic diseases. Despite widespread recommendations for twice-daily tooth brushing, adherence to recommended oral self-care behaviors remains sub-optimal due to factors such as forgetfulness and disengagement. To address this, we developed Oralytics, a mHealth intervention system designed to complement clinician-delivered preventative care for marginalized individuals at risk for dental disease. Oralytics incorporates an online reinforcement learning algorithm to determine optimal times to deliver intervention prompts that encourage oral self-care behaviors. We have deployed Oralytics in a registered clinical trial. The deployment required careful design to manage challenges specific to the clinical trials setting in the U.S. In this paper, we (1) highlight key design decisions of the RL algorithm that address these challenges and (2) conduct a re-sampling analysis to evaluate algorithm design decisions. A second phase (randomized control trial) of Oralytics is planned to start in spring 2025.

Oralytics Reinforcement Learning Algorithm

Dental disease is still one of the most common chronic diseases in the United States. While dental disease is preventable through healthy oral self-care behaviors (OSCB), this basic behavior is not consistently practiced. We have developed Oralytics, an online, reinforcement learning (RL) algorithm that optimizes the delivery of personalized intervention prompts to improve OSCB. In this paper, we offer a full overview of algorithm design decisions made using prior data, domain expertise, and experiments in a simulation test bed. The finalized RL algorithm was deployed in the Oralytics clinical trial, conducted from fall 2023 to summer 2024.

The Fallacy of Minimizing Local Regret in the Sequential Task Setting

In the realm of Reinforcement Learning (RL), online RL is often conceptualized as an optimization problem, where an algorithm interacts with an unknown environment to minimize cumulative regret. In a stationary setting, strong theoretical guarantees, like a sublinear ($\sqrt{T}$) regret bound, can be obtained, which typically implies the convergence to an optimal policy and the cessation of exploration. However, these theoretical setups often oversimplify the complexities encountered in real-world RL implementations, where tasks arrive sequentially with substantial changes between tasks and the algorithm may not be allowed to adaptively learn within certain tasks. We study the changes beyond the outcome distributions, encompassing changes in the reward designs (mappings from outcomes to rewards) and the permissible policy spaces. Our results reveal the fallacy of myopically minimizing regret within each task: obtaining optimal regret rates in the early tasks may lead to worse rates in the subsequent ones, even when the outcome distributions stay the same. To realize the optimal cumulative regret bound across all the tasks, the algorithm has to overly explore in the earlier tasks. This theoretical insight is practically significant, suggesting that due to unanticipated changes (e.g., rapid technological development or human-in-the-loop involvement) between tasks, the algorithm needs to explore more than it would in the usual stationary setting within each task. Such implication resonates with the common practice of using clipped policies in mobile health clinical trials and maintaining a fixed rate of $\epsilon$-greedy exploration in robotic learning.

Towards Optimizing Human-Centric Objectives in AI-Assisted Decision-Making With Offline Reinforcement Learning

As AI assistance is increasingly infused into decision-making processes, we may seek to optimize human-centric objectives beyond decision accuracy, such as skill improvement or task enjoyment of individuals interacting with these systems. With this aspiration in mind, we propose offline reinforcement learning (RL) as a general approach for modeling human-AI decision-making to optimize such human-centric objectives. Our approach seeks to optimize different objectives by adaptively providing decision support to humans -- the right type of assistance, to the right person, at the right time. We instantiate our approach with two objectives: human-AI accuracy on the decision-making task and human learning about the task, and learn policies that optimize these two objectives from previous human-AI interaction data. We compare the optimized policies against various baselines in AI-assisted decision-making. Across two experiments (N = 316 and N = 964), our results consistently demonstrate that people interacting with policies optimized for accuracy achieve significantly better accuracy -- and even human-AI complementarity -- compared to those interacting with any other type of AI support. Our results further indicate that human learning is more difficult to optimize than accuracy, with participants who interacted with learning-optimized policies showing significant learning improvement only at times. Our research (1) demonstrates offline RL to be a promising approach to model dynamics of human-AI decision-making, leading to policies that may optimize various human-centric objectives and provide novel insights about the AI-assisted decision-making space, and (2) emphasizes the importance of considering human-centric objectives beyond decision accuracy in AI-assisted decision-making, while also opening up the novel research challenge of optimizing such objectives.

Monitoring Fidelity of Online Reinforcement Learning Algorithms in Clinical Trials

Online reinforcement learning (RL) algorithms offer great potential for personalizing treatment for participants in clinical trials. However, deploying an online, autonomous algorithm in the high-stakes healthcare setting makes quality control and data quality especially difficult to achieve. This paper proposes algorithm fidelity as a critical requirement for deploying online RL algorithms in clinical trials. It emphasizes the responsibility of the algorithm to (1) safeguard participants and (2) preserve the scientific utility of the data for post-trial analyses. We also present a framework for pre-deployment planning and real-time monitoring to help algorithm developers and clinical researchers ensure algorithm fidelity. To illustrate our framework's practical application, we present real-world examples from the Oralytics clinical trial. Since Spring 2023, this trial successfully deployed an autonomous, online RL algorithm to personalize behavioral interventions for participants at risk for dental disease.

Non-Stationary Latent Auto-Regressive Bandits

We consider the stochastic multi-armed bandit problem with non-stationary rewards. We present a novel formulation of non-stationarity in the environment where changes in the mean reward of the arms over time are due to some unknown, latent, auto-regressive (AR) state of order $k$. We call this new environment the latent AR bandit. Different forms of the latent AR bandit appear in many real-world settings, especially in emerging scientific fields such as behavioral health or education where there are few mechanistic models of the environment. If the AR order $k$ is known, we propose an algorithm that achieves $\tilde{O}(k\sqrt{T})$ regret in this setting. Empirically, our algorithm outperforms standard UCB across multiple non-stationary environments, even if $k$ is mis-specified.

The Unintended Consequences of Discount Regularization: Improving Regularization in Certainty Equivalence Reinforcement Learning

Discount regularization, using a shorter planning horizon when calculating the optimal policy, is a popular choice to restrict planning to a less complex set of policies when estimating an MDP from sparse or noisy data (Jiang et al., 2015). It is commonly understood that discount regularization functions by de-emphasizing or ignoring delayed effects. In this paper, we reveal an alternate view of discount regularization that exposes unintended consequences. We demonstrate that planning under a lower discount factor produces an identical optimal policy to planning using any prior on the transition matrix that has the same distribution for all states and actions. In fact, it functions like a prior with stronger regularization on state-action pairs with more transition data. This leads to poor performance when the transition matrix is estimated from data sets with uneven amounts of data across state-action pairs. Our equivalence theorem leads to an explicit formula to set regularization parameters locally for individual state-action pairs rather than globally. We demonstrate the failures of discount regularization and how we remedy them using our state-action-specific method across simple empirical examples as well as a medical cancer simulator.

Assessing the Impact of Context Inference Error and Partial Observability on RL Methods for Just-In-Time Adaptive Interventions

Just-in-Time Adaptive Interventions (JITAIs) are a class of personalized health interventions developed within the behavioral science community. JITAIs aim to provide the right type and amount of support by iteratively selecting a sequence of intervention options from a pre-defined set of components in response to each individual's time varying state. In this work, we explore the application of reinforcement learning methods to the problem of learning intervention option selection policies. We study the effect of context inference error and partial observability on the ability to learn effective policies. Our results show that the propagation of uncertainty from context inferences is critical to improving intervention efficacy as context uncertainty increases, while policy gradient algorithms can provide remarkable robustness to partially observed behavioral state information.

Reward Design For An Online Reinforcement Learning Algorithm Supporting Oral Self-Care

Dental disease is one of the most common chronic diseases despite being largely preventable. However, professional advice on optimal oral hygiene practices is often forgotten or abandoned by patients. Therefore patients may benefit from timely and personalized encouragement to engage in oral self-care behaviors. In this paper, we develop an online reinforcement learning (RL) algorithm for use in optimizing the delivery of mobile-based prompts to encourage oral hygiene behaviors. One of the main challenges in developing such an algorithm is ensuring that the algorithm considers the impact of the current action on the effectiveness of future actions (i.e., delayed effects), especially when the algorithm has been made simple in order to run stably and autonomously in a constrained, real-world setting (i.e., highly noisy, sparse data). We address this challenge by designing a quality reward which maximizes the desired health outcome (i.e., high-quality brushing) while minimizing user burden. We also highlight a procedure for optimizing the hyperparameters of the reward by building a simulation environment test bed and evaluating candidates using the test bed. The RL algorithm discussed in this paper will be deployed in Oralytics, an oral self-care app that provides behavioral strategies to boost patient engagement in oral hygiene practices.