{
  "gate_summary": {
    "productive_hours_error_gate": "fail",
    "proxy_average_pprn_error_gate": "fail",
    "subgroup_fairness_gate": "descriptive_not_nationally_tested",
    "uncertainty_coverage_gate": "pass",
    "unit_peak_pprn_gate": "not_tested",
    "yes_no_sensitivity_specificity_gate": "fail"
  },
  "model_version": "national-safe-staffing-v0.14.0-ma-icu-expansion",
  "productive_paid_hour_conversion": {
    "acceptance_targets": {
      "nominal_90_interval_coverage_max": 0.95,
      "nominal_90_interval_coverage_min": 0.85,
      "rn_hppd_median_absolute_percentage_error_max": 0.1
    },
    "held_out_hospital_count": 241,
    "implied_pprn_median_absolute_percentage_error": 0.13818846941872764,
    "implied_pprn_p90_absolute_percentage_error": 0.4117671832234866,
    "method": "deterministic_5_fold_hospital_holdout",
    "nominal_90_interval_empirical_coverage": 0.8962655601659751,
    "passes_interval_coverage_gate": true,
    "passes_rn_hppd_error_gate": false,
    "productive_hours_median_absolute_percentage_error": 0.1377127021875736,
    "productive_hours_p90_absolute_percentage_error": 0.3763702875367269,
    "scope_warning": "Validates only the hospital-level paid-hours conversion within the California overlap; not the unit-level peak PPRN or final verdict."
  },
  "proxy_vs_confirmed_aggregate": {
    "comparator_status": "better-input aggregate comparator; not shift-level ground truth",
    "excluded_sources": {
      "massachusetts_icu_reports": "partial ICU coverage",
      "oregon_staffing_investigation_reports": "violation-selected partial shifts",
      "vermont_nurse_staffing_reports": "partial listed-unit coverage"
    },
    "important_limits": [
      "Confirmed B inputs are annual or quarterly aggregates and do not observe the 90th-percentile shift.",
      "The confirmed verdict uses the same unvalidated peak-factor method, so verdict agreement does not validate the peak factor.",
      "Hospital aggregate proxy PPRN and patient-day-weighted unit PPRN are not perfectly equivalent constructs.",
      "The validation sample covers only states with full-facility normalized B data and is not nationally representative."
    ],
    "model_version": "national-safe-staffing-v0.14.0-ma-icu-expansion",
    "overall": {
      "absolute_error_gate_max_patients_per_rn": 0.75,
      "hospital_count": 592,
      "median_absolute_error_pprn": 1.0662862699091677,
      "median_absolute_percentage_error": 0.3510969628852639,
      "no_sensitivity": 0.17270194986072424,
      "p90_absolute_error_pprn": 3.087651479704109,
      "passes_absolute_error_gate": false,
      "passes_no_sensitivity_gate": false,
      "passes_yes_specificity_gate": true,
      "proxy_no_count": 87,
      "proxy_yes_count": 505,
      "reference_no_count": 359,
      "reference_yes_count": 233,
      "sensitivity_specificity_gate_min": 0.8,
      "verdict_accuracy": 0.4560810810810811,
      "yes_specificity": 0.8927038626609443
    },
    "strata": {
      "by_confirmed_source": [
        {
          "acceptance_eligible": true,
          "confirmed_source_id": "hcai_hospital_financials",
          "hospital_count": 371,
          "median_absolute_error_pprn": 1.0873383694001244,
          "median_absolute_percentage_error": 0.37024983313285714,
          "no_sensitivity": 0.21962616822429906,
          "p90_absolute_error_pprn": 4.587037304563705,
          "proxy_no_count": 64,
          "proxy_yes_count": 307,
          "reference_no_count": 214,
          "reference_yes_count": 157,
          "verdict_accuracy": 0.5040431266846361,
          "yes_specificity": 0.89171974522293
        },
        {
          "acceptance_eligible": true,
          "confirmed_source_id": "illinois_hospital_report_card",
          "hospital_count": 160,
          "median_absolute_error_pprn": 1.132650677371481,
          "median_absolute_percentage_error": 0.3727678625592536,
          "no_sensitivity": 0.058823529411764705,
          "p90_absolute_error_pprn": 2.2165220267967802,
          "proxy_no_count": 13,
          "proxy_yes_count": 147,
          "reference_no_count": 85,
          "reference_yes_count": 75,
          "verdict_accuracy": 0.45,
          "yes_specificity": 0.8933333333333333
        },
        {
          "acceptance_eligible": true,
          "confirmed_source_id": "nj_staffing_reports",
          "hospital_count": 61,
          "median_absolute_error_pprn": 0.8095442321216519,
          "median_absolute_percentage_error": 0.24430361970371287,
          "no_sensitivity": 0.16666666666666666,
          "p90_absolute_error_pprn": 1.7451115156515689,
          "proxy_no_count": 10,
          "proxy_yes_count": 51,
          "reference_no_count": 60,
          "reference_yes_count": 1,
          "verdict_accuracy": 0.18032786885245902,
          "yes_specificity": 1.0
        }
      ],
      "by_hospital_type": [
        {
          "acceptance_eligible": false,
          "hospital_count": 9,
          "hospital_type": "children",
          "median_absolute_error_pprn": 0.8610458427762429,
          "median_absolute_percentage_error": 0.4392864786270301,
          "no_sensitivity": 1.0,
          "p90_absolute_error_pprn": 1.933204444796742,
          "proxy_no_count": 9,
          "proxy_yes_count": 0,
          "reference_no_count": 2,
          "reference_yes_count": 7,
          "verdict_accuracy": 0.2222222222222222,
          "yes_specificity": 0.0
        },
        {
          "acceptance_eligible": true,
          "hospital_count": 89,
          "hospital_type": "critical_access",
          "median_absolute_error_pprn": 0.8819784717140509,
          "median_absolute_percentage_error": 0.30531523698483826,
          "no_sensitivity": 0.0,
          "p90_absolute_error_pprn": 1.8743470190200355,
          "proxy_no_count": 0,
          "proxy_yes_count": 89,
          "reference_no_count": 24,
          "reference_yes_count": 65,
          "verdict_accuracy": 0.7303370786516854,
          "yes_specificity": 1.0
        },
        {
          "acceptance_eligible": true,
          "hospital_count": 421,
          "hospital_type": "general_acute",
          "median_absolute_error_pprn": 0.9698746839323933,
          "median_absolute_percentage_error": 0.34418029341581935,
          "no_sensitivity": 0.11510791366906475,
          "p90_absolute_error_pprn": 2.468563739595791,
          "proxy_no_count": 43,
          "proxy_yes_count": 378,
          "reference_no_count": 278,
          "reference_yes_count": 143,
          "verdict_accuracy": 0.38954869358669836,
          "yes_specificity": 0.9230769230769231
        },
        {
          "acceptance_eligible": false,
          "hospital_count": 20,
          "hospital_type": "ltach",
          "median_absolute_error_pprn": 2.351598672588853,
          "median_absolute_percentage_error": 0.45274308787756773,
          "no_sensitivity": 0.0,
          "p90_absolute_error_pprn": 3.260683669306368,
          "proxy_no_count": 0,
          "proxy_yes_count": 20,
          "reference_no_count": 17,
          "reference_yes_count": 3,
          "verdict_accuracy": 0.15,
          "yes_specificity": 1.0
        },
        {
          "acceptance_eligible": false,
          "hospital_count": 3,
          "hospital_type": "other",
          "median_absolute_error_pprn": 0.5356424934184894,
          "median_absolute_percentage_error": 0.2343651219527282,
          "no_sensitivity": 0.0,
          "p90_absolute_error_pprn": 0.6819284306557837,
          "proxy_no_count": 0,
          "proxy_yes_count": 3,
          "reference_no_count": 1,
          "reference_yes_count": 2,
          "verdict_accuracy": 0.6666666666666666,
          "yes_specificity": 1.0
        },
        {
          "acceptance_eligible": true,
          "hospital_count": 36,
          "hospital_type": "psychiatric",
          "median_absolute_error_pprn": 4.9102571774092505,
          "median_absolute_percentage_error": 0.5037332292043742,
          "no_sensitivity": 1.0,
          "p90_absolute_error_pprn": 9.31947579063883,
          "proxy_no_count": 35,
          "proxy_yes_count": 1,
          "reference_no_count": 28,
          "reference_yes_count": 8,
          "verdict_accuracy": 0.8055555555555556,
          "yes_specificity": 0.125
        },
        {
          "acceptance_eligible": false,
          "hospital_count": 14,
          "hospital_type": "rehabilitation",
          "median_absolute_error_pprn": 2.0709899157009817,
          "median_absolute_percentage_error": 0.4229776287961212,
          "no_sensitivity": 0.0,
          "p90_absolute_error_pprn": 5.210212803347234,
          "proxy_no_count": 0,
          "proxy_yes_count": 14,
          "reference_no_count": 9,
          "reference_yes_count": 5,
          "verdict_accuracy": 0.35714285714285715,
          "yes_specificity": 1.0
        }
      ],
      "by_proxy_evidence_grade": [
        {
          "acceptance_eligible": true,
          "hospital_count": 404,
          "median_absolute_error_pprn": 0.971313938082799,
          "median_absolute_percentage_error": 0.34413733250666756,
          "no_sensitivity": 0.11764705882352941,
          "p90_absolute_error_pprn": 2.427055381601985,
          "proxy_evidence_grade": "C",
          "proxy_no_count": 39,
          "proxy_yes_count": 365,
          "reference_no_count": 272,
          "reference_yes_count": 132,
          "verdict_accuracy": 0.3886138613861386,
          "yes_specificity": 0.946969696969697
        },
        {
          "acceptance_eligible": true,
          "hospital_count": 188,
          "median_absolute_error_pprn": 1.2781012402740837,
          "median_absolute_percentage_error": 0.3831454894881082,
          "no_sensitivity": 0.3448275862068966,
          "p90_absolute_error_pprn": 5.550393305010426,
          "proxy_evidence_grade": "D",
          "proxy_no_count": 48,
          "proxy_yes_count": 140,
          "reference_no_count": 87,
          "reference_yes_count": 101,
          "verdict_accuracy": 0.601063829787234,
          "yes_specificity": 0.8217821782178217
        }
      ],
      "by_state": [
        {
          "acceptance_eligible": true,
          "hospital_count": 371,
          "median_absolute_error_pprn": 1.0873383694001244,
          "median_absolute_percentage_error": 0.37024983313285714,
          "no_sensitivity": 0.21962616822429906,
          "p90_absolute_error_pprn": 4.587037304563705,
          "proxy_no_count": 64,
          "proxy_yes_count": 307,
          "reference_no_count": 214,
          "reference_yes_count": 157,
          "state": "CA",
          "verdict_accuracy": 0.5040431266846361,
          "yes_specificity": 0.89171974522293
        },
        {
          "acceptance_eligible": true,
          "hospital_count": 160,
          "median_absolute_error_pprn": 1.132650677371481,
          "median_absolute_percentage_error": 0.3727678625592536,
          "no_sensitivity": 0.058823529411764705,
          "p90_absolute_error_pprn": 2.2165220267967802,
          "proxy_no_count": 13,
          "proxy_yes_count": 147,
          "reference_no_count": 85,
          "reference_yes_count": 75,
          "state": "IL",
          "verdict_accuracy": 0.45,
          "yes_specificity": 0.8933333333333333
        },
        {
          "acceptance_eligible": true,
          "hospital_count": 61,
          "median_absolute_error_pprn": 0.8095442321216519,
          "median_absolute_percentage_error": 0.24430361970371287,
          "no_sensitivity": 0.16666666666666666,
          "p90_absolute_error_pprn": 1.7451115156515689,
          "proxy_no_count": 10,
          "proxy_yes_count": 51,
          "reference_no_count": 60,
          "reference_yes_count": 1,
          "state": "NJ",
          "verdict_accuracy": 0.18032786885245902,
          "yes_specificity": 1.0
        }
      ]
    },
    "subgroup_fairness_status": "descriptive_only_not_nationally_validated",
    "subgroup_median_absolute_error_spread": 4.100712945287599,
    "validation_design": "Frozen pre-state C/D hospital aggregate predictions compared with full-facility B state observations from NJ, CA, and IL."
  },
  "publication_conclusion": "C/D outputs remain directional estimates. The full-facility B comparison measures aggregate input and verdict agreement, but it does not validate actual high-load shifts, the peak factor, or national subgroup fairness.",
  "validation_status": "partial_not_nationally_validated"
}