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Before using an AI forecast to plan flu staffing or beds, define the exact admissions decision it is meant to support, then test the model on local, time-ordered data against a simple baseline. Evaluate uncertainty and performance during rapid rises and falls—not just average accuracy—and set governance, fallback, and monitoring rules before deployment.
Start by defining the forecast and the decision
A forecast is only useful if its target matches the operational question. Write down what counts as an admission, which facility or catchment area is covered, when each forecast is made, how far ahead it predicts, and when the input data are considered complete. Name the decision the forecast may inform, such as staffing levels or bed capacity, and specify what planners should do when a forecast is missing or uncertain.
Keep aggregate operational forecasting distinct from patient-level clinical prediction. A forecast of state or county admissions does not, by itself, establish how many patients a particular hospital will admit or how many beds it will need. CDC’s FluSight evaluates weekly influenza hospital admissions for the current week and up to three weeks ahead across U.S. jurisdictions; a hospital should not assume those targets are interchangeable with its own.
Use a reproducible, local evaluation
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Request a model and data account
Obtain the model family and version, target definition, training and validation periods, data sources, data latency and revision practices, missing-data handling, update history, intended population, uncertainty outputs, known limitations, and conditions where the model should not be used. CDC required FluSight teams to provide model metadata, including method information, before submitting forecasts.
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Test with information available at the forecast date
Use time-ordered evaluation: predictions should be made from data that would actually have been available at the time, then compared with later finalized observations. Keep model selection separate from the final evaluation period to reduce leakage. Where practical, evaluate more than one flu season and run a prospective silent test using the intended production feeds and workflow. These are recommended design choices, not universal CDC requirements.
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Check the setting where the model will be used
Break out results by lead time and facility or geography. CDC reports jurisdiction-specific differences in its 2025–2026 evaluation, so a national average or another health system’s result is not evidence that the model will perform similarly at your hospital. Also document whether local coding, admission definitions, or reporting patterns differ from the data used to develop the model.
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Agree on acceptable performance before reviewing results
Set decision-specific tolerances in advance—for example, how large a bed-planning miss is operationally unacceptable and how long a miss may persist before escalation. The reviewed CDC and ASTP sources do not establish a universal threshold for an acceptable error, so hospitals need to define one for their own use case.
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Score the forecast, its uncertainty, and the baseline
A point forecast alone hides whether the model communicates risk usefully. For probabilistic forecasts, report interval scores such as weighted interval score (WIS), interval coverage at each stated nominal level, and calibration by horizon. Coverage measures how often the observed outcome falls inside the model’s prediction interval; compare observed coverage with the interval’s stated level. An interval that is too narrow may look decisive while missing outcomes that matter for capacity planning.
Compare the model with a transparent baseline chosen in advance, such as carrying forward the prior week’s admissions. CDC uses that carry-forward approach for FluSight and reports relative WIS. A relative WIS below 1 indicates better performance than the baseline; CDC calculates the relative measure from model and baseline comparisons over shared targets. Include decision-facing results as well: how often the forecast would have led to too few staffed beds, how large misses were, and how long they lasted.
CDC’s 2025–2026 results illustrate why no single summary score is enough:
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| Finding | What it says—and does not say |
|---|---|
| 34 teams submitted 53 unique flu admission forecasting models; 39 met inclusion criteria (CDC, 2026). | The evaluation compared a substantial set of submissions, but inclusion does not establish suitability for an individual hospital. |
| 33 of 39 included models performed better than the carry-forward baseline (CDC, 2026). | Most models beat this simple benchmark on the reported evaluation; this does not guarantee good performance at every lead time or during every turning point. |
| The FluSight ensemble ranked seventh of 39 on average relative WIS and was one of 12 models that consistently outperformed the baseline in all jurisdictions (CDC, 2026). | A strong overall or cross-jurisdiction result can coexist with weak coverage in a particular period. |
| For the ensemble’s two-week horizon, fewer than 25% of prediction intervals across jurisdictions contained observations around the week ending December 27, 2025; coverage stabilized near 95% starting in February 2026 (CDC, 2026). | Forecast reliability changed over the season. These are CDC FluSight results, not a performance estimate for a hospital’s local model. |
Stress-test turning points and data problems
Review model behavior around flu onset, peaks, steep declines, unusual local outbreaks, reporting backlogs, and changes in testing or admission definitions. In CDC’s 2025–2026 evaluation, the FluSight ensemble’s 50% and 95% intervals did not anticipate the late-December increase and mid-January decrease. Its two-week-horizon coverage fell below 25% around the week ending December 27, 2025, before stabilizing near 95% beginning in February. A model can therefore perform well on average yet be least reliable during the weeks when planners may need warning most.
Also test delayed, missing, revised, or out-of-distribution inputs. Require visible data-quality warnings and uncertainty information, and define a fallback procedure—for example, which existing operational process takes over and who is notified. Measure whether forecasts remain usable under those conditions rather than treating clean historical data as representative of every production week.
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For a facility-level model, compare errors, interval coverage, and failure rates across relevant sites and operating conditions. If the model predicts patient-level outcomes, identify population groups relevant to that clinical task and compare performance across them using data appropriate to the target. Check whether missingness, access to testing, or coding practices vary across groups; report limitations where sample sizes are too small for stable estimates.
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Do not treat aggregate jurisdiction-level forecast performance as evidence of patient-level fairness. ASTP’s 2024 survey found that 74% of surveyed non-federal acute care hospitals evaluated predictive AI for bias, but the survey covers predictive AI broadly and does not prescribe a single fairness measure for flu admission forecasting.
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Give the evaluation shared but explicit ownership. Name a clinical sponsor and an operational owner, and involve analytics or data engineering, IT and security, quality and safety, and governance or compliance as appropriate. Decide who can approve use, review model updates, investigate incidents, and pause or suspend the forecast when local risk warrants it.
ASTP’s 2024 survey of non-federal acute care hospitals found that 74% reported multiple entities accountable for evaluating predictive AI. A predictive-AI committee or task force was reported by 66%, and division or department leaders by 60%. These findings describe hospital predictive AI broadly, not flu-specific governance practices.
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Before launch, define a monitoring cadence and indicators that match the forecast’s use:
- Data freshness, missingness, and unexpected revisions.
- Forecast scores and interval coverage as outcomes become available, broken out by horizon and relevant site or group.
- Changes in results after a model or data-pipeline update.
- Use of fallback procedures, escalation events, and operational consequences of misses.
Set investigation or suspension triggers based on the decision risk and the tolerances agreed in advance. ASTP reported that 79% of surveyed non-federal acute care hospitals conducted post-implementation evaluation or monitoring of predictive AI in 2024. That figure is not specific to flu forecasting, but it underscores that evaluation does not end at approval.
How to compare candidate models
When assessing more than one candidate, use the same targets, evaluation periods, and baseline wherever possible. Compare local performance, interval score and coverage, horizon and geography, behavior during rapid changes, tolerance of delayed or missing data, subgroup and site differences, communication of uncertainty and fallback behavior, and the reproducibility of model updates. A model that wins on average relative WIS may still be a poor operational choice if it fails at the lead time or turning point that matters most to your hospital.
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