Incentivizing Tool-Use Reinforcement Learning for Post-Arrival Emergency Care Prediction

Large language models (LLMs) can reason over both structured measurements and free-text records, which makes them attractive for emergency department (ED) prediction. However, most existing LLMs still fall short of conventional ML methods like trees on EHR-based prediction tasks. Our controlled analysis traces this gap to two weaknesses: LLMs do not select informative features, and they misjudge what numerical values imply for risk even when given the right features. We propose TIR-EC, a tool-integrated reinforcement learning framework that addresses both. TIR-EC exposes EHR feature groups as tools the LLM can call. It trains the LLM with rewards from a gradient-boosted tree teacher, whic...

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