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Intervention Granularity Matters: Coherent Treatment Bundles in Counterfactual Simulation with Clinical World Models

arXiv · AI, language, vision and robotics · article · Sep 18, 2026 · UTC

Counterfactual simulation with a clinical world model means fixing a patient's history, changing the treatment, and reading off the predicted response. Doing so requires deciding what counts as one intervention. In clinical settings, interventions are documented as bundles: a co-occurrence audit of 945,707 patient-hours from MIMIC-IV shows groups of components, such as every parameter of a dialysis circuit, that never appear apart, so an edit that changes one component on its own describes an hour that never occurs in the data. We hypothesize that the granularity at which an intervention is ed

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