Auditable Context-Aware HFMD Forecasting with Structured LLM Agents
Authors: Joongwon Chae, Runming Wang, Chen Xiong, Gong Yunhan, Lian Zhang, Ji Jiansong, Dongmei Yu, Peiwu Qin
Organizations: Institute of Biomedicine and Health Engineering, Tsinghua Shenzhen International Graduate School (SIGS), Tsinghua University, Shenzhen, China · The First Hospital of Hebei Medical University, Shijiazhuang, China · The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China · Hengqin Laboratory, Zhuhai, China
Abstract
Effective HFMD surveillance requires forecasts capturing both time-series patterns and contextual drivers such as school calendars, weather, and policy or surveillance reports. In clinical settings, forecasts must be trusted and actionable; thus, beyond point accuracy, decision-makers require concise, auditable explanations of why risk is expected to rise or fall. Classical models (e.g., ARIMA and Prophet) and foundation models (e.g., Chronos, Moirai, and TimesFM) treat external covariates as numerical inputs, lacking semantic reasoning to reflect epidemiological mechanisms or resolve conflicting signals. We propose a two-agent neuro-symbolic framework that decouples contextual interpretation from probabilistic forecasting. An LLM-based Event Interpreter ingests heterogeneous signals -- school schedules, weather summaries, government reports, and clinical guidelines -- and outputs a scalar transmission-impact signal. A Forecast Generator combines this signal with historical case counts to produce point forecasts that are mapped to probabilistic predictions through Poisson/negative-binomial moment matching. We focus on one-week-ahead rolling forecasts, aligning with weekly hospital-capacity planning and the rapid, context-driven inflections typical of HFMD. We evaluate on two datasets: Hong Kong surveillance (90 target weeks in 2023--2024) and Lishui hospital visits (33 target weeks in 2024). Against traditional and foundation-model baselines, our approach achieves competitive point accuracy while providing robust 90% intervals (coverage approximately 0.85--1.00) and concise rationales. This demonstrates that integrating domain knowledge through LLM-based agents can match strong numerical forecasters while yielding interpretable, context-aware forecasts aligned with public-health decision-making.
Medical and public health experts must make real-time resource decisions, such as expanding hospital bed capacity, based on projected hospitalization trends during large-scale healthcare disruptions (e.g., operational failures or pandemics). Forecasting models can assist in this task by analyzing large volumes of resource-related data at the facility level, but they must be reliable for decision-making under real-world data conditions. Recent work shows that large language models (LLMs) can incorporate richer forms of context into numerical forecasting. Whereas traditional models rely primarily on temporal context (i.e., past observations), LLMs can also leverage non-temporal public health context such as demographic, geographic, and population-level features. However, it remains unclear how these models should be used to produce stable or decision-relevant predictions in real-world healthcare settings. To evaluate how LLMs can be effectively used in this setting, we evaluate three approaches across 60 counties with low-,mid-, and high-hospitalization intensities in the United States: direct LLM-based forecasting, classical time-series models, and a context-augmented hybrid pipeline (HybridARX) that incorporates LLM-derived signals into structured models. Because the goal is operational decision-making rather than error minimization alone, we evaluate performance with bias and lead-lag alignment in addition to standard forecasting metrics. Our results show that HybridARX improves over classical ARX by yielding more stable and better-calibrated forecasts, particularly when incorporating noisy contextual signals into structured time-series models. These findings suggest that, in non-stationary healthcare resource forecasting, LLMs are most useful when embedded within structured hybrid models.
Time series forecasting has advanced rapidly, especially with the emergence of foundation models that show strong zero-shot performance on numerical extrapolation. However, in real-world forecasting settings, a statistically plausible baseline is rarely the final forecast used in practice. Before a forecast becomes decision-ready, it often needs to be revised using weakly structured business context such as holiday effects, campaign plans, external events, historical analogs, and expert feedback. This practical stage remains underexplored in the forecasting literature. In this paper, we formulate this stage as the \textbf{last-mile forecasting} problem and present an LLM-agent framework that sits on top of a forecasting backbone. Our system maintains a unified forecast workspace, invokes tools to retrieve contextual evidence, and converts reasoning trajectories into explicit forecast revision actions under structural safety constraints. It also supports long-horizon forecasting through map-reduce-style decomposition and post-hoc reflection through a memory bank. The resulting system is designed to be controllable and auditable. Through real-world case studies, we show how LLM agents can bridge the gap between statistical prediction and business-ready forecasting.
Time series forecasting is fundamental to decision-making in complex systems, where future dynamics are influenced not only by historical observations but also by evolving contextual features. Recent advances in large language models (LLMs) have extended forecasting beyond numerical extrapolation toward context-aware reasoning. However, existing approaches often lack explicit mechanisms to identify relevant contexts, reason about their impacts, and validate forecasts against temporal and domain constraints. In this work, we propose CastFSR, an agentic framework that formulates context-aware forecasting as a Fast--Slow--Reflect workflow. In fast thinking, CastFSR profiles observations and selects lightweight forecasters to construct a data-driven forecast prior. In slow deliberation, it retrieves contextual evidence, adaptively determines informative look-back windows, and reasons about how contexts reshape future dynamics. In reflection, it iteratively refines forecasts to ensure temporal, contextual, and domain consistency. CastFSR supports both training-free inference with off-the-shelf LLMs and efficient deployment through a two-stage SFT and reinforcement learning strategy that transfers its orchestration capability to compact LLMs. Extensive experiments on public datasets demonstrate that CastFSR consistently outperforms representative baselines. Our code is available at https://github.com/Xiaoyu-Tao/CastFSR.