Gradient Boosted Risk Scores

Many clinical risk scores are deployed as additive rules with nonnegative integer points assigned to relevant binary predictive features. These integer weights not only make the score easier to use in practice but also promote sparsity in the resulting prediction model. Such risk scores are often derived by first fitting a regression model and then rounding the estimated coefficients to the nearest integer after appropriate scaling. This approach is computationally fast but does not guarantee optimality of the resulting score. Alternatively, one may search over all possible integer weights to directly optimize a value function by posing the problem as an integer programming task. However, the associated computational burden can be substantial, especially when the value function is nonconcave or even discontinuous. In this paper, we develop new machine learning algorithms that employ a flexible greedy optimization strategy to learn such additive scoring directly under explicit and sensible optimality objectives. We apply the proposed method to a large electronic health record (EHR) cohort in Epic Cosmos to construct an integer-weighted comorbidity score for measuring the risk of post-discharge mortality. We also conduct a simulation study to examine the finite-sample operating characteristics.

Risk scoring systems are widely used in high-stakes domains to assist decision-making. However, existing approaches often focus on optimizing predictive accuracy or likelihood-based criteria, which may not align with the main goal of maximizing utility. In this paper, we propose a novel risk scoring system that directly optimizes net benefit over a range of decision thresholds. The model is formulated as a sparse integer linear programming problem which enables the construction of a transparent scoring system with integer coefficients, and hence, facilitates interpretation and practical application. We also establish fundamental relationships among net benefit, discrimination, and calibration. Our analysis proves that optimizing net benefit also guarantees conventional performance measures. We evaluated our method on multiple public datasets as well as on a large-scale credit risk dataset. This computational study demonstrated that our interpretable method can effectively achieve high net benefit while maintaining competitive discrimination and calibration performance.

Gradient boosted decision trees require a stopping rule to avoid overfitting. The standard rule monitors a validation loss and stops if the loss fails to improve for a fixed patience period. However, the patience parameter has no interpretable scale and validation losses can be noisy or implicitly defined by a user-specified gradient. We propose ScoreStop, a gradient-based early-stopping rule that casts the stopping decision at each iteration as a test of the null hypothesis that the current predictor is the population risk minimizer. We use a functional score test, computed on validation data, with a statistic that is scale-invariant in the update direction, with a known asymptotic distribution under the null. Because our test uses gradients rather than loss values, the same construction applies to implicit losses such as LambdaRank, and data-dependent losses such as Cox regression via influence functions. In synthetic experiments and real-data benchmarks, we show that ScoreStop is competitive with loss-based methods.