Joint Score-Threshold Optimization for Interpretable Risk Assessment Under Partial Supervision

Abstract: Risk assessment tools in healthcare commonly employ point-based scoring systems that map patients to ordinal risk categories via thresholds. While electronic health record (EHR) data presents opportunities for data-driven optimization of these tools, two fundamental challenges impede standard supervised learning: (1) partial supervision arising from intervention-censored outcomes, where only extreme categories can be reliably labeled, and (2) asymmetric misclassification costs that increase with ordinal distance. We propose a mixed-integer programming (MIP) framework that jointly optimizes scoring weights and category thresholds under these constraints. Our approach handles partial supervision through per-instance feasible label sets, incorporates asymmetric distance-aware objectives, and prevents middle-category collapse via minimum threshold gaps. We further develop a CSO relaxation using softplus losses that preserves the ordinal structure while enabling efficient optimization. The framework supports governance constraints including sign restrictions, sparsity, and minimal modifications to incumbent tools, ensuring practical deployability in clinical workflows.