# From Static Risk to Dynamic Trajectories: Toward World-Model-Inspired Clinical Prediction

arXiv: https://arxiv.org/abs/2605.16927 · HTML: https://mlsanity.com/paper/2605.16927/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 42 of its 104 references that are in the map.
- First posted on arXiv 16 May 2026.

## Builds on (most cited first, 30 of 42)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Learning Phrase Representations using RNN Encoder-Decoder for Statistical Machine Translation](https://mlsanity.com/paper/1406.1078/) (2014)
- [Neural Ordinary Differential Equations](https://mlsanity.com/paper/1806.07366/) (2018)
- [An Empirical Evaluation of Generic Convolutional and Recurrent Networks for Sequence Modeling](https://mlsanity.com/paper/1803.01271/) (2018)
- [Recurrent Neural Networks for Multivariate Time Series with Missing Values](https://mlsanity.com/paper/1606.01865/) (2016)
- [Neural Controlled Differential Equations for Irregular Time Series](https://mlsanity.com/paper/2005.08926/) (2020)
- [Med-BERT: pre-trained contextualized embeddings on large-scale structured electronic health records for disease prediction](https://mlsanity.com/paper/2005.12833/) (2020)
- [RETAIN: An Interpretable Predictive Model for Healthcare using Reverse Time Attention Mechanism](https://mlsanity.com/paper/1608.05745/) (2016)
- [Scalable and accurate deep learning for electronic health records](https://mlsanity.com/paper/1801.07860/) (2018)
- [BEHRT: Transformer for Electronic Health Records](https://mlsanity.com/paper/1907.09538/) (2019)
- [Doctor AI: Predicting Clinical Events via Recurrent Neural Networks](https://mlsanity.com/paper/1511.05942/) (2015)
- [Latent ODEs for Irregularly-Sampled Time Series](https://mlsanity.com/paper/1907.03907/) (2019)
- [GRAM: Graph-based Attention Model for Healthcare Representation Learning](https://mlsanity.com/paper/1611.07012/) (2016)
- [Estimating Counterfactual Treatment Outcomes over Time Through Adversarially Balanced Representations](https://mlsanity.com/paper/2002.04083/) (2020)
- [Causal Transformer for Estimating Counterfactual Outcomes](https://mlsanity.com/paper/2204.07258/) (2022)
- [Time Series Deconfounder: Estimating Treatment Effects over Time in the Presence of Hidden Confounders](https://mlsanity.com/paper/1902.00450/) (2019)
- [Causal machine learning for predicting treatment outcomes](https://mlsanity.com/paper/2410.08770/) (2024)
- [Continuous State-Space Models for Optimal Sepsis Treatment - a Deep Reinforcement Learning Approach](https://mlsanity.com/paper/1705.08422/) (2017)
- [Continuous-Time Modeling of Counterfactual Outcomes Using Neural Controlled Differential Equations](https://mlsanity.com/paper/2206.08311/) (2022)
- [A Multi-Center Study on the Adaptability of a Shared Foundation Model for Electronic Health Records](https://mlsanity.com/paper/2311.11483/) (2023)
- [Bayesian Neural Controlled Differential Equations for Treatment Effect Estimation](https://mlsanity.com/paper/2310.17463/) (2023)
- [Predicting the impact of treatments over time with uncertainty aware neural differential equations](https://mlsanity.com/paper/2202.11987/) (2022)
- [Estimating Individual Treatment Effects with Time-Varying Confounders](https://mlsanity.com/paper/2008.13620/) (2020)
- [Has Multimodal Learning Delivered Universal Intelligence in Healthcare? A Comprehensive Survey](https://mlsanity.com/paper/2408.12880/) (2024)
- [EHRWorld: A Patient-Centric Medical World Model for Long-Horizon Clinical Trajectories](https://mlsanity.com/paper/2602.03569/) (2026)
- [Counterfactual Generative Models for Time-Varying Treatments](https://mlsanity.com/paper/2305.15742/) (2023)
- [Accounting For Informative Sampling When Learning to Forecast Treatment Outcomes Over Time](https://mlsanity.com/paper/2306.04255/) (2023)
- [G-Net: A Deep Learning Approach to G-computation for Counterfactual Outcome Prediction Under Dynamic Treatment Regimes](https://mlsanity.com/paper/2003.10551/) (2020)
- [A Framework for Individualizing Predictions of Disease Trajectories by Exploiting Multi-Resolution Structure](https://mlsanity.com/paper/1601.04674/) (2016)
- [Causal Graph ODE: Continuous Treatment Effect Modeling in Multi-agent Dynamical Systems](https://mlsanity.com/paper/2403.00178/) (2024)

## Abstract (arXiv)

Clinical decision-making is a feedback system where risk estimates influence treatment, which in turn changes disease trajectories, and both shape clinicians' measurement practices. Static prediction often fails clinically: models trained on observational care logs conflate disease biology with clinician behavior, particularly under treatment confounder feedback and irregular or informative observation. This Review focuses on intervention-aware disease trajectory modeling in clinical AI--methods estimating patient-specific longitudinal disease evolution and assessing trajectory changes under alternative treatments. We organize the field around six linked components: three decision tasks (factual forecasting, counterfactual estimation, policy evaluation) and three data-generating mechanisms (disease evolution, treatment assignment, observation process) that determine identifiability. We present the first unified framework bridging forecasting, counterfactual trajectories, and policy evaluation across discrete/continuous time, explicitly addressing treatment assignment, time-varying confounding, and observation bias. We synthesize key method families (multistate/joint models, temporal point-process, deep sequence architectures, longitudinal causal inference), map them to relevant components, and align evaluation with claim strength via overlap diagnostics, uncertainty quantification, off-policy robustness, and target-trial validation. This synthesis advances benchmark prediction to decision-grade clinical evidence, enabling treatment-sensitive individualized futures, pre-deployment policy stress-testing, and safer closed-loop learning health systems that adapt/abstain when evidence is insufficient.