Deep Learning on Hester Davis Scores for Inpatient Fall Prediction

Fall risk prediction among hospitalized patients is a critical aspect of patient safety in clinical settings, and accurate models can help prevent adverse events. The Hester Davis Score (HDS) is commonly used to assess fall risk, with current clinical practice relying on a threshold-based approach. In this method, a patient is classified as high-risk when their HDS exceeds a predefined threshold. However, this approach may fail to capture dynamic patterns in fall risk over time. In this study, we model the threshold-based approach and propose two machine learning approaches for enhanced fall prediction: One-step ahead fall prediction and sequence-to-point fall prediction. The one-step ahead model uses the HDS at the current timestamp to predict the risk at the next timestamp, while the sequence-to-point model leverages all preceding HDS values to predict fall risk using deep learning. We compare these approaches to assess their accuracy in fall risk prediction, demonstrating that deep learning can outperform the traditional threshold-based method by capturing temporal patterns and improving prediction reliability. These findings highlight the potential for data-driven approaches to enhance patient safety through more reliable fall prevention strategies.

Process-Supervised Reward Models for Clinical Note Generation: A Scalable Approach Guided by Domain Expertise

Process-supervised reward models (PRMs), which verify large language model (LLM) outputs step-by-step, have achieved significant success in mathematical and coding problems. However, their application to other domains remains largely unexplored. In this work, we train a PRM to provide step-level reward signals for clinical notes generated by LLMs from patient-doctor dialogues. Guided by real-world clinician expertise, we carefully designed step definitions for clinical notes and utilized Gemini-Pro 1.5 to automatically generate process supervision data at scale. Our proposed PRM, trained on the LLaMA-3.1 8B instruct model, demonstrated superior performance compared to Gemini-Pro 1.5 and an outcome-supervised reward model (ORM) across two key evaluations: (1) the accuracy of selecting gold-reference samples from error-containing samples, achieving 98.8% (versus 61.3% for ORM and 93.8% for Gemini-Pro 1.5), and (2) the accuracy of selecting physician-preferred notes, achieving 56.2% (compared to 51.2% for ORM and 50.0% for Gemini-Pro 1.5). Additionally, we conducted ablation studies to determine optimal loss functions and data selection strategies, along with physician reader studies to explore predictors of downstream Best-of-N performance. Our promising results suggest the potential of PRMs to extend beyond the clinical domain, offering a scalable and effective solution for diverse generative tasks.

Towards Adapting Open-Source Large Language Models for Expert-Level Clinical Note Generation

Large Language Models (LLMs) have shown promising capabilities in handling clinical text summarization tasks. In this study, we demonstrate that a small open-source LLM can be effectively trained to generate high-quality clinical notes from outpatient patient-doctor dialogues. We achieve this through a comprehensive domain- and task-specific adaptation process for the LLaMA-2 13 billion parameter model. This process incorporates continued pre-training, supervised fine-tuning, and reinforcement learning from both AI and human feedback. We introduced an enhanced approach, termed DistillDirect, for performing on-policy reinforcement learning with Gemini Pro serving as the teacher model. Our resulting model, LLaMA-Clinic, is capable of generating clinical notes that are comparable in quality to those authored by physicians. In a blinded physician reader study, the majority (90.4%) of individual evaluations rated the notes generated by LLaMA-Clinic as "acceptable" or higher across all three criteria: real-world readiness, completeness, and accuracy. Notably, in the more challenging "Assessment and Plan" section, LLaMA-Clinic scored higher (4.2/5) in real-world readiness compared to physician-authored notes (4.1/5). Additionally, we identified caveats in public clinical note datasets, such as ACI-BENCH. We highlight key considerations for future clinical note-generation tasks, emphasizing the importance of pre-defining a best-practice note format. Overall, our research demonstrates the potential and feasibility of training smaller, open-source LLMs to assist with clinical documentation, capitalizing on healthcare institutions' access to patient records and domain expertise. We have made our newly created synthetic clinic dialogue-note dataset and the physician feedback dataset publicly available to foster future research in this field.