基于同伴锚定的反事实路径规划用于慢性健康管理

中文摘要 AI 辅助

慢性病管理中的有效行为干预需要的不是单一处方，而是一系列渐进步骤，每一步都锚定于真实、相似个体已切实达成的成就。反事实解释为这类指导提供了一条自然的计算路径，回答何种行为改变本可产生更佳结果。但现有方法仅返回目标状态而不提供达成路径，无法保证沿途健康状况单调改善，也不从同伴行为中汲取证据——要求患者在一步之内弥合巨大差距，而这恰恰是最不可能被尝试的推荐结构。我们提出POROS（基于同伴锚定的状态间最优路径），一个植根于班杜拉自我效能理论与费斯廷格社会比较理论的领域无关框架，其构建行为进展图——一个有向无环图，节点为观察到的患者状态，每条边同时要求同伴锚定的行为邻近性与严格的健康结局改善。因此，每条边都是队列中个体已证明可在单一周期内实现的行为改变。通过该图的最小成本路径将原本不可行的行为差距分解为渐进的、同伴锚定的步骤。我们在两个独立的糖尿病患者纵向队列上评估POROS。对于低于70%临床目标范围内时间（TIR，血糖处于70-180 mg/dL）阈值的患者，该方法将一个队列中每步所需的平均增益从26.3个百分点（pp）降至5.5 pp，在另一个队列中从31.1 pp降至5.7 pp，将大的行为跳跃分解为自我效能所需的渐进步骤。在两个队列中，97-98%的多跳路径跨越患者边界，从而在构造上嵌入了社会比较。

英文摘要

Effective behavioral intervention in chronic disease management requires not a single prescription but a sequence of incremental steps, each grounded in what real, similar individuals have demonstrably achieved. Counterfactual explanation offers a natural computational route to such guidance, answering what change in behavior would have produced a better outcome. But existing methods return a target state without a route to it, guarantee no monotone health improvement along the way, and draw no evidence from peer behavior -- asking a patient to close a wide gap in one move, which is precisely the recommendation structure least likely to be attempted. We propose POROS (Peer-Grounded Optimal Routes Over States), a domain-agnostic framework rooted in Bandura's self-efficacy theory and Festinger's social comparison theory that constructs a Behavioral Progression Graph -- a directed acyclic graph over observed patient states in which every edge requires both peer-grounded behavioral proximity and strict health outcome improvement. Every edge is therefore a behavioral change that individuals in the cohort have demonstrated is achievable within a single period. Minimum-cost paths through this graph decompose otherwise inactionable behavioral gaps into incremental, peer-grounded steps. We evaluate POROS on two independent longitudinal cohorts of patients with diabetes. For patients below the 70% clinical threshold for time in range (TIR, blood glucose within 70-180 mg/dL), it reduces the mean gain required per step from 26.3 percentage points (pp) to 5.5 pp on one cohort and from 31.1 pp to 5.7 pp on the other, decomposing large behavioral jumps into the incremental steps that self-efficacy requires. Across both cohorts, 97-98% of multi-hop paths cross patient boundaries, embedding social comparison by construction.

发表机构

• Arizona State University（亚利桑那州立大学）

机构由 AI 辅助整理，请以论文原文为准。