Coverage-Controlled Preference Mining from Noisy Claim Verification for Evidence-Grounded Generation
Authors: Weixin Liu, Congning Ni, Qingyuan Song, Susannah L. Rose, Murat Kantarcioglu, Bradley A. Malin, Zhijun Yin
Organizations: Vanderbilt University, Nashville, TN, USA · Vanderbilt University Medical Center, Nashville, TN, USA · Virginia Tech, Blacksburg, VA, USA
Evidence-grounded generation produces summaries whose claims should be supported by supplied evidence, but claim-level verifiers provide noisy feedback and can reward models that simply say less. We study this problem in clinical Brief Hospital Course summarization, where outputs must remain grounded in patient-specific EHR evidence. We introduce VERI-DPO, a preference-mining framework that converts noisy claim verification into coverage-controlled summary-level preferences. For each evidence-window prompt, VERI-DPO samples multiple candidate summaries, decomposes them into claims, verifies each claim against patient evidence, and forms a preference pair only when the chosen summary has better aggregate verifier-estimated support while retaining comparable verifiable content. Standard Direct Preference Optimization then distills these pairs into a single-sample policy, avoiding inference-time reranking. On patient-disjoint MIMIC-III-Ext-VeriFact-BHC test data, VERI-DPO reduces Not Supported rates from 10.7% to 1.9% under the mining verifier and from 11.6% to 6.4% under a separately prompted GPT-4o judge. In 100 blinded pairwise assessments by two domain researchers, VERI-DPO is preferred over the base model 56 times versus 18 times for factual faithfulness. In a locked zero-shot MIMIC-IV-Ext-BHC transfer test with 1,000 patients and no model adaptation, VERI-DPO lowers Not Supported rates with nearly unchanged scored-claim counts. Multi-seed ablations show that verifier-guided pair construction drives the gains, while coverage and anti-degeneration controls prevent apparent factuality improvements from coming from shorter or less checkable outputs.
Longitudinal electronic health records (EHRs) capture years of patient history across notes, codes, labs, and procedures, and contain evidence needed to reason about likely clinical outcomes. However, comprehensive clinician review of these records is impractical, and LLM-based processing is costly and often unreliable, missing some relevant observations while hallucinating others. We therefore propose EviGen, a three-layer framework for verifiable clinical rationale generation that addresses these challenges. The first layer is a patient-conditioned retriever that uses learnable queries to find evidence predictive of, not just textually relevant to, a clinical outcome and ranks it by prediction attribution scores. The second layer is an LLM generator that consumes this ranked evidence as a scaffold to produce a clinical rationale grounded in the retrieved spans. The third layer is a process-supervised verifier that checks the generated rationale at the reasoning-step level, flagging unreliable claims. Across three medical prediction datasets, EviGen improves prediction performance and rationale faithfulness over full-context LLM and RAG baselines, and is preferred by clinical reviewers in a usability evaluation.
Biomedical fact-checking systems must do more than predict whether a claim is supported, contradicted, or unaddressed: they should also produce evidence that is faithful, complete, and useful for verification. We study this evidence-generation setting on CARE-XAI, a unified benchmark spanning five biomedical and health fact-checking sources. We compare base instruction LLMs, PubMed retrieval-augmented LLMs, fine-tuned LLMs, label-only LLMs, and biomedical encoder classifiers under a shared evaluation protocol. Biomedical classifiers remain strongest for verdict-only prediction, while fine-tuned LLMs are the strongest evidence-generating systems. PubMed retrieval is mixed: it helps PubMed-aligned sources such as PubMedQA and SciFact, but can distract models on broader public-health claims. We introduce Bio-GRACE, a gold-reference-normalized diagnostic for measuring whether retrieved evidence recovers the decision benefit of reference evidence. Bio-GRACE shows that retrieval utility is source-dependent, motivates selective retrieval, and exposes why retrieval recall and lexical evidence overlap are insufficient for biomedical fact-checking.
BoN improves model outputs by sampling several candidates and selecting one with a proxy score, but it assumes that complete candidates can be evaluated reliably. Many vision-language tasks instead provide only partial verification: a finding, span, value, region, or relation may be checkable even when no dependable whole-response verifier exists. Moreover, the same claim may recur across candidates with opposing stances, allowing one observation to support part of the pool and contradict another. We introduce Best-of-Evidence (BoE), an inference-time selection framework that keeps the BoN candidate pool fixed, represents reusable claims with a signed candidate--factor graph, and allocates a limited budget to evidence actions that can change the final choice. BoE formalizes selection under partial verification and provides a practical score-based controller, with the zero-budget case recovering the underlying BoN decision. Theoretically, we show that residual evidence capacity limits any evidence-driven improvement and that shared factor queries can achieve an O(log K) versus Θ(K) query separation in a factor-code model. Common-ledger experiments on four medical VQA settings show that BoE can improve fixed-pool selection and rescue some BoN failures when evidence is reliable, contrastive, and decision-relevant, while also revealing the channel-quality and candidate-generation limits that prevent universal gains.