Patient Outcome Predictions Improve Operations at a Large Hospital Network

Problem definition: Access to accurate predictions of patients' outcomes can enhance medical staff's decision-making, which ultimately benefits all stakeholders in the hospitals. A large hospital network in the US has been collaborating with academics and consultants to predict short-term and long-term outcomes for all inpatients across their seven hospitals. Methodology/results: We develop machine learning models that predict the probabilities of next 24-hr/48-hr discharge and intensive care unit transfers, end-of-stay mortality and discharge dispositions. All models achieve high out-of-sample AUC (75.7%-92.5%) and are well calibrated. In addition, combining 48-hr discharge predictions with doctors' predictions simultaneously enables more patient discharges (10%-28.7%) and fewer 7-day/30-day readmissions ($p$-value $<0.001$). We implement an automated pipeline that extracts data and updates predictions every morning, as well as user-friendly software and a color-coded alert system to communicate these patient-level predictions (alongside explanations) to clinical teams. Managerial implications: Since we have been gradually deploying the tool, and training medical staff, over 200 doctors, nurses, and case managers across seven hospitals use it in their daily patient review process. We observe a significant reduction in the average length of stay (0.67 days per patient) following its adoption and anticipate substantial financial benefits (between \$55 and \$72 million annually) for the healthcare system.

TabText: a Systematic Approach to Aggregate Knowledge Across Tabular Data Structures

Processing and analyzing tabular data in a productive and efficient way is essential for building successful applications of machine learning in fields such as healthcare. However, the lack of a unified framework for representing and standardizing tabular information poses a significant challenge to researchers and professionals alike. In this work, we present TabText, a methodology that leverages the unstructured data format of language to encode tabular data from different table structures and time periods efficiently and accurately. We show using two healthcare datasets and four prediction tasks that features extracted via TabText outperform those extracted with traditional processing methods by 2-5%. Furthermore, we analyze the sensitivity of our framework against different choices for sentence representations of missing values, meta information and language descriptiveness, and provide insights into winning strategies that improve performance.

Integrated multimodal artificial intelligence framework for healthcare applications

Artificial intelligence (AI) systems hold great promise to improve healthcare over the next decades. Specifically, AI systems leveraging multiple data sources and input modalities are poised to become a viable method to deliver more accurate results and deployable pipelines across a wide range of applications. In this work, we propose and evaluate a unified Holistic AI in Medicine (HAIM) framework to facilitate the generation and testing of AI systems that leverage multimodal inputs. Our approach uses generalizable data pre-processing and machine learning modeling stages that can be readily adapted for research and deployment in healthcare environments. We evaluate our HAIM framework by training and characterizing 14,324 independent models based on MIMIC-IV-MM, a multimodal clinical database (N=34,537 samples) containing 7,279 unique hospitalizations and 6,485 patients, spanning all possible input combinations of 4 data modalities (i.e., tabular, time-series, text and images), 11 unique data sources and 12 predictive tasks. We show that this framework can consistently and robustly produce models that outperform similar single-source approaches across various healthcare demonstrations (by 6-33%), including 10 distinct chest pathology diagnoses, along with length-of-stay and 48-hour mortality predictions. We also quantify the contribution of each modality and data source using Shapley values, which demonstrates the heterogeneity in data type importance and the necessity of multimodal inputs across different healthcare-relevant tasks. The generalizable properties and flexibility of our Holistic AI in Medicine (HAIM) framework could offer a promising pathway for future multimodal predictive systems in clinical and operational healthcare settings.