The Evidence Ladder for Reinforcement Learning in Healthcare: From Retrospective Policies to Trusted Interventions

The paper introduces an evidence ladder for evaluating reinforcement learning (RL) in healthcare, outlining stages from problem formulation to lifecycle monitoring. It argues that success in historical data does not guarantee real‑world improvement and highlights assumptions and failure modes at each rung. The authors propose reporting practices to support cumulative evaluation and emphasize that RL should be tested as an intervention within a dynamic sociotechnical system.

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• reinforcement-learning