{"id":"https://openalex.org/W7160921908","doi":"https://doi.org/10.48550/arxiv.2605.09584","title":"CLR-voyance: Reinforcing Open-Ended Reasoning for Inpatient Clinical Decision Support with Outcome-Aware Rubrics","display_name":"CLR-voyance: Reinforcing Open-Ended Reasoning for Inpatient Clinical Decision Support with Outcome-Aware Rubrics","publication_year":2026,"publication_date":"2026-05-10","ids":{"openalex":"https://openalex.org/W7160921908","doi":"https://doi.org/10.48550/arxiv.2605.09584"},"language":null,"primary_location":{"id":"doi:10.48550/arxiv.2605.09584","is_oa":true,"landing_page_url":"https://doi.org/10.48550/arxiv.2605.09584","pdf_url":null,"source":{"id":"https://openalex.org/S4306400194","display_name":"arXiv (Cornell University)","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"host_organization":"https://openalex.org/I205783295","host_organization_name":"Cornell University","host_organization_lineage":["https://openalex.org/I205783295"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":null,"is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"Preprint"},"type":"preprint","indexed_in":["datacite"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://doi.org/10.48550/arxiv.2605.09584","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5135958954","display_name":"Aishik Nagar","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Nagar, Aishik","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5107526312","display_name":"Arun-Kumar Kaliya-Perumal","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Kaliya-Perumal, Arun-Kumar","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5135956137","display_name":"Yu-Hsuan Han","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Han, Yu-Hsuan","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5135912282","display_name":"Andrew Sheng-Han Huang","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Huang, Andrew Sheng-Han","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5130058109","display_name":"Kristen Kee","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Kee, Kristen","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5061828250","display_name":"Yushi Cao","orcid":"https://orcid.org/0000-0002-2886-4121"},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Cao, Yushi","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5135999740","display_name":"Yiming Chen","orcid":"https://orcid.org/0009-0000-4099-1273"},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Chen, Yiming","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"last","author":{"id":"https://openalex.org/A5135322656","display_name":"Hongchao Jiang","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Jiang, Hongchao","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T13702","display_name":"Machine Learning in Healthcare","score":0.6741999983787537,"subfield":{"id":"https://openalex.org/subfields/1702","display_name":"Artificial Intelligence"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},"topics":[{"id":"https://openalex.org/T13702","display_name":"Machine Learning in Healthcare","score":0.6741999983787537,"subfield":{"id":"https://openalex.org/subfields/1702","display_name":"Artificial Intelligence"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T12574","display_name":"Clinical Reasoning and Diagnostic Skills","score":0.14720000326633453,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10028","display_name":"Topic Modeling","score":0.06199999898672104,"subfield":{"id":"https://openalex.org/subfields/1702","display_name":"Artificial Intelligence"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/rubric","display_name":"Rubric","score":0.8705999851226807},{"id":"https://openalex.org/keywords/pairwise-comparison","display_name":"Pairwise comparison","score":0.44670000672340393},{"id":"https://openalex.org/keywords/decision-support-system","display_name":"Decision support system","score":0.4359000027179718},{"id":"https://openalex.org/keywords/action","display_name":"Action (physics)","score":0.4284999966621399},{"id":"https://openalex.org/keywords/process","display_name":"Process (computing)","score":0.4000000059604645},{"id":"https://openalex.org/keywords/inference","display_name":"Inference","score":0.3804999887943268},{"id":"https://openalex.org/keywords/verifiable-secret-sharing","display_name":"Verifiable secret sharing","score":0.36480000615119934},{"id":"https://openalex.org/keywords/oracle","display_name":"Oracle","score":0.35249999165534973}],"concepts":[{"id":"https://openalex.org/C111640148","wikidata":"https://www.wikidata.org/wiki/Q847349","display_name":"Rubric","level":2,"score":0.8705999851226807},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.4934999942779541},{"id":"https://openalex.org/C184898388","wikidata":"https://www.wikidata.org/wiki/Q1435712","display_name":"Pairwise comparison","level":2,"score":0.44670000672340393},{"id":"https://openalex.org/C107327155","wikidata":"https://www.wikidata.org/wiki/Q330268","display_name":"Decision support system","level":2,"score":0.4359000027179718},{"id":"https://openalex.org/C2780791683","wikidata":"https://www.wikidata.org/wiki/Q846785","display_name":"Action (physics)","level":2,"score":0.4284999966621399},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.4235000014305115},{"id":"https://openalex.org/C98045186","wikidata":"https://www.wikidata.org/wiki/Q205663","display_name":"Process (computing)","level":2,"score":0.4000000059604645},{"id":"https://openalex.org/C2776214188","wikidata":"https://www.wikidata.org/wiki/Q408386","display_name":"Inference","level":2,"score":0.3804999887943268},{"id":"https://openalex.org/C509550671","wikidata":"https://www.wikidata.org/wiki/Q126945","display_name":"Medical education","level":1,"score":0.37529999017715454},{"id":"https://openalex.org/C85847156","wikidata":"https://www.wikidata.org/wiki/Q59015987","display_name":"Verifiable secret sharing","level":3,"score":0.36480000615119934},{"id":"https://openalex.org/C55166926","wikidata":"https://www.wikidata.org/wiki/Q2892946","display_name":"Oracle","level":2,"score":0.35249999165534973},{"id":"https://openalex.org/C3020452639","wikidata":"https://www.wikidata.org/wiki/Q454812","display_name":"Clinical judgment","level":2,"score":0.3199000060558319},{"id":"https://openalex.org/C63527458","wikidata":"https://www.wikidata.org/wiki/Q5133829","display_name":"Clinical decision support system","level":3,"score":0.31470000743865967},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.3075999915599823},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.3046000003814697},{"id":"https://openalex.org/C75630572","wikidata":"https://www.wikidata.org/wiki/Q538904","display_name":"Applied psychology","level":1,"score":0.3005000054836273},{"id":"https://openalex.org/C535046627","wikidata":"https://www.wikidata.org/wiki/Q30612","display_name":"Clinical trial","level":2,"score":0.29409998655319214},{"id":"https://openalex.org/C102655426","wikidata":"https://www.wikidata.org/wiki/Q940923","display_name":"Psychodynamics","level":2,"score":0.28999999165534973},{"id":"https://openalex.org/C2781234862","wikidata":"https://www.wikidata.org/wiki/Q6543077","display_name":"Licensure","level":2,"score":0.28769999742507935},{"id":"https://openalex.org/C106189395","wikidata":"https://www.wikidata.org/wiki/Q176789","display_name":"Markov decision process","level":3,"score":0.2827000021934509},{"id":"https://openalex.org/C204434341","wikidata":"https://www.wikidata.org/wiki/Q357789","display_name":"Adjudication","level":2,"score":0.28200000524520874},{"id":"https://openalex.org/C156201811","wikidata":"https://www.wikidata.org/wiki/Q5418360","display_name":"Evidential reasoning approach","level":4,"score":0.2736000120639801},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.2734000086784363},{"id":"https://openalex.org/C37335422","wikidata":"https://www.wikidata.org/wiki/Q6888134","display_name":"Model-based reasoning","level":3,"score":0.2696000039577484},{"id":"https://openalex.org/C2778533338","wikidata":"https://www.wikidata.org/wiki/Q7935148","display_name":"Virtual patient","level":2,"score":0.26899999380111694},{"id":"https://openalex.org/C55439883","wikidata":"https://www.wikidata.org/wiki/Q360812","display_name":"Correctness","level":2,"score":0.25360000133514404}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.48550/arxiv.2605.09584","is_oa":true,"landing_page_url":"https://doi.org/10.48550/arxiv.2605.09584","pdf_url":null,"source":{"id":"https://openalex.org/S4306400194","display_name":"arXiv (Cornell University)","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"host_organization":"https://openalex.org/I205783295","host_organization_name":"Cornell University","host_organization_lineage":["https://openalex.org/I205783295"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":null,"is_accepted":false,"is_published":null,"raw_source_name":null,"raw_type":"Preprint"}],"best_oa_location":{"id":"doi:10.48550/arxiv.2605.09584","is_oa":true,"landing_page_url":"https://doi.org/10.48550/arxiv.2605.09584","pdf_url":null,"source":{"id":"https://openalex.org/S4306400194","display_name":"arXiv (Cornell University)","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"host_organization":"https://openalex.org/I205783295","host_organization_name":"Cornell University","host_organization_lineage":["https://openalex.org/I205783295"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":null,"is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"Preprint"},"sustainable_development_goals":[{"score":0.7691491842269897,"display_name":"Peace, Justice and strong institutions","id":"https://metadata.un.org/sdg/16"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":[],"abstract_inverted_index":{"Inpatient":[0],"clinical":[1,42,114,139,155,222,225],"reasoning":[2,57,115,156,170],"is":[3,117],"a":[4,52,59,89,104,190,196,243],"sequential":[5],"decision":[6],"under":[7],"partial":[8],"observability:":[9],"the":[10,13,20,79,97,109,120,123,231],"clinician":[11,198],"sees":[12],"admission":[14],"so":[15],"far":[16],"and":[17,33,66,75,92,108,133,144,175,178,209,224],"must":[18],"choose":[19],"next":[21],"action":[22],"whose":[23],"downstream":[24],"consequences":[25],"are":[26,72,128],"not":[27],"yet":[28],"visible.":[29],"Existing":[30],"clinical-LLM":[31],"evaluations":[32],"RL":[34],"rewards":[35,70],"signals":[36],"collapse":[37],"this":[38],"into":[39,88],"closed-form":[40],"retrieval,":[41],"journey":[43],"leakage,":[44],"or":[45,181],"unanchored":[46],"LLM-as-judge":[47],"scoring.":[48],"We":[49,77,141],"introduce":[50],"CLR-voyance,":[51],"framework":[53],"that":[54,71],"reformulates":[55],"inpatient":[56,138,154,251],"as":[58,81],"Partially":[60],"Observable":[61],"Markov":[62],"Decision":[63],"Process":[64],"(POMDP)":[65],"supervises":[67],"it":[68],"with":[69,146],"simultaneously":[73],"outcome-grounded":[74],"clinician-validated.":[76],"instantiate":[78],"formulation":[80],"CLR-POMDP,":[82,165],"which":[83,116,228],"partitions":[84],"successful":[85],"patient":[86,124],"journeys":[87],"policy-visible":[90],"past":[91,98],"an":[93,100],"oracle-only":[94],"future.":[95],"Using":[96],"information,":[99],"oracle":[101],"LLM":[102],"generates":[103],"case-specific":[105],"query-answer":[106],"pair,":[107],"first":[110],"adaptive":[111],"rubric":[112],"for":[113,130,137,239],"verifiable":[118],"in":[119],"future":[121],"of":[122,135,167,214,249],"journey.":[125],"These":[126],"rubrics":[127],"used":[129],"both":[131],"post-training":[132],"evaluation":[134],"models":[136,171],"reasoning.":[140,216],"post-train":[142],"Qwen3-8B":[143],"MedGemma-4B":[145],"GRPO":[147],"followed":[148],"by":[149],"model":[150,215],"merging,":[151],"yielding":[152],"state-of-the-art":[153],"while":[157],"retaining":[158],"generalist":[159],"capabilities.":[160],"CLR-voyance-8B":[161],"achieves":[162],"84.91%":[163],"on":[164,184,221],"ahead":[166],"frontier":[168],"medical":[169,186],"like":[172],"GPT-5":[173],"(77.83%)":[174],"MedGemma-27B":[176],"(66.66%)":[177],"has":[179,236],"comparable":[180],"better":[182],"performance":[183],"existing":[185],"benchmarks.":[187],"To":[188],"ensure":[189],"clinically":[191],"meaningful":[192],"setting,":[193],"we":[194],"conduct":[195],"large-scale":[197],"alignment":[199],"study,":[200],"where":[201],"physicians":[202],"curate":[203],"per-case":[204],"rubrics,":[205],"grade":[206],"candidate":[207],"responses,":[208],"provide":[210],"blinded":[211],"pairwise":[212],"preferences":[213],"This":[217],"study":[218],"provides":[219],"insights":[220],"LLM-as-a-judge":[223],"preference-model":[226],"selection,":[227],"can":[229],"inform":[230],"community":[232],"at":[233,242],"large.":[234],"CLR-voyance":[235],"been":[237],"deployed":[238],"6+":[240],"months":[241],"partner":[244],"public":[245],"hospital,":[246],"drafting":[247],"thousands":[248],"reasoning-heavy":[250],"notes.":[252]},"counts_by_year":[],"updated_date":"2026-07-01T06:00:48.157686","created_date":"2026-05-13T00:00:00"}
