Heart failure (HF) is one of the leading causes of rehospitalization among older adults in the United States. Although clinical notes contain rich, detailed patient information and make up a large portion of electronic health records (EHRs), they remain underutilized for HF readmission risk analysis. Traditional computational models for HF readmission often rely on expert-crafted rules, medical thesauri, and ontologies to interpret clinical notes, which are typically written under time pressure and may contain misspellings, abbreviations, and domain-specific jargon. We present ClinNoteAgents, an LLM-based multi-agent framework that transforms free-text clinical notes into (1) structured representations of clinical and social risk factors for association analysis and (2) clinician-style abstractions for HF 30-day readmission prediction. We evaluate ClinNoteAgents on 3,544 notes from 2,065 patients (readmission rate=35.16%), demonstrating strong performance in extracting risk factors from free-text, identifying key contributing factors, and predicting readmission risk. By reducing reliance on structured fields and minimizing manual annotation and model training, ClinNoteAgents provides a scalable and interpretable approach to note-based HF readmission risk modeling in data-limited healthcare systems.

AI models are often evaluated based on their ability to predict the outcome of interest. However, in many AI for social impact applications, the presence of an intervention that affects the outcome can bias the evaluation. Randomized controlled trials (RCTs) randomly assign interventions, allowing data from the control group to be used for unbiased model evaluation. However, this approach is inefficient because it ignores data from the treatment group. Given the complexity and cost often associated with RCTs, making the most use of the data is essential. Thus, we investigate model evaluation strategies that leverage all data from an RCT. First, we theoretically quantify the estimation bias that arises from naïvely aggregating performance estimates from treatment and control groups and derive the condition under which this bias leads to incorrect model selection. Leveraging these theoretical insights, we propose nuisance parameter weighting (NPW), an unbiased model evaluation approach that reweights data from the treatment group to mimic the distributions of samples that would or would not experience the outcome under no intervention. Using synthetic and real-world datasets, we demonstrate that our proposed evaluation approach consistently yields better model selection than the standard approach, which ignores data from the treatment group, across various intervention effect and sample size settings. Our contribution represents a meaningful step towards more efficient model evaluation in real-world contexts.

Hospitals and healthcare systems rely on operational decisions that determine patient flow, cost, and quality of care. Despite strong performance on medical knowledge and conversational benchmarks, foundation models trained on general text may lack the specialized knowledge required for these operational decisions. We introduce Lang1, a family of models (100M-7B parameters) pretrained on a specialized corpus blending 80B clinical tokens from NYU Langone Health's EHRs and 627B tokens from the internet. To rigorously evaluate Lang1 in real-world settings, we developed the REalistic Medical Evaluation (ReMedE), a benchmark derived from 668,331 EHR notes that evaluates five critical tasks: 30-day readmission prediction, 30-day mortality prediction, length of stay, comorbidity coding, and predicting insurance claims denial. In zero-shot settings, both general-purpose and specialized models underperform on four of five tasks (36.6%-71.7% AUROC), with mortality prediction being an exception. After finetuning, Lang1-1B outperforms finetuned generalist models up to 70x larger and zero-shot models up to 671x larger, improving AUROC by 3.64%-6.75% and 1.66%-23.66% respectively. We also observed cross-task scaling with joint finetuning on multiple tasks leading to improvement on other tasks. Lang1-1B effectively transfers to out-of-distribution settings, including other clinical tasks and an external health system. Our findings suggest that predictive capabilities for hospital operations require explicit supervised finetuning, and that this finetuning process is made more efficient by in-domain pretraining on EHR. Our findings support the emerging view that specialized LLMs can compete with generalist models in specialized tasks, and show that effective healthcare systems AI requires the combination of in-domain pretraining, supervised finetuning, and real-world evaluation beyond proxy benchmarks.

Carbapenemase-Producing Enterobacteriace poses a critical concern for infection prevention and control in hospitals. However, predictive modeling of previously highlighted CPE-associated risks such as readmission, mortality, and extended length of stay (LOS) remains underexplored, particularly with modern deep learning approaches. This study introduces an eXplainable AI modeling framework to investigate CPE impact on patient outcomes from Electronic Medical Records data of an Irish hospital. We analyzed an inpatient dataset from an Irish acute hospital, incorporating diagnostic codes, ward transitions, patient demographics, infection-related variables and contact network features. Several Transformer-based architectures were benchmarked alongside traditional machine learning models. Clinical outcomes were predicted, and XAI techniques were applied to interpret model decisions. Our framework successfully demonstrated the utility of Transformer-based models, with TabTransformer consistently outperforming baselines across multiple clinical prediction tasks, especially for CPE acquisition (AUROC and sensitivity). We found infection-related features, including historical hospital exposure, admission context, and network centrality measures, to be highly influential in predicting patient outcomes and CPE acquisition risk. Explainability analyses revealed that features like "Area of Residence", "Admission Ward" and prior admissions are key risk factors. Network variables like "Ward PageRank" also ranked highly, reflecting the potential value of structural exposure information. This study presents a robust and explainable AI framework for analyzing complex EMR data to identify key risk factors and predict CPE-related outcomes. Our findings underscore the superior performance of the Transformer models and highlight the importance of diverse clinical and network features.

We introduce the Functional Competing Risk Net (FCRN), a unified deep-learning framework for discrete-time survival analysis under competing risks, which seamlessly integrates functional covariates and handles missing data within an end-to-end model. By combining a micro-network Basis Layer for functional data representation with a gradient-based imputation module, FCRN simultaneously learns to impute missing values and predict event-specific hazards. Evaluated on multiple simulated datasets and a real-world ICU case study using the MIMIC-IV and Cleveland Clinic datasets, FCRN demonstrates substantial improvements in prediction accuracy over random survival forests and traditional competing risks models. This approach advances prognostic modeling in critical care by more effectively capturing dynamic risk factors and static predictors while accommodating irregular and incomplete data.

Intensive Care Unit (ICU) patients often present with complex, overlapping signs of physiological deterioration that require timely escalation of care. Traditional early warning systems, such as SOFA or MEWS, are limited by their focus on single outcomes and fail to capture the multi-dimensional nature of clinical decline. This study proposes a multi-label classification framework to predict Care Escalation Triggers (CETs), including respiratory failure, hemodynamic instability, renal compromise, and neurological deterioration, using the first 24 hours of ICU data. Using the MIMIC-IV database, CETs are defined through rule-based criteria applied to data from hours 24 to 72 (for example, oxygen saturation below 90, mean arterial pressure below 65 mmHg, creatinine increase greater than 0.3 mg/dL, or a drop in Glasgow Coma Scale score greater than 2). Features are extracted from the first 24 hours and include vital sign aggregates, laboratory values, and static demographics. We train and evaluate multiple classification models on a cohort of 85,242 ICU stays (80 percent training: 68,193; 20 percent testing: 17,049). Evaluation metrics include per-label precision, recall, F1-score, and Hamming loss. XGBoost, the best performing model, achieves F1-scores of 0.66 for respiratory, 0.72 for hemodynamic, 0.76 for renal, and 0.62 for neurologic deterioration, outperforming baseline models. Feature analysis shows that clinically relevant parameters such as respiratory rate, blood pressure, and creatinine are the most influential predictors, consistent with the clinical definitions of the CETs. The proposed framework demonstrates practical potential for early, interpretable clinical alerts without requiring complex time-series modeling or natural language processing.

Accurate prediction of clinical outcomes using Electronic Health Records (EHRs) is critical for early intervention, efficient resource allocation, and improved patient care. EHRs contain multimodal data, including both structured data and unstructured clinical notes that provide rich, context-specific information. In this work, we introduce a unified framework that seamlessly integrates these diverse modalities, leveraging all relevant available information through a two-stage architecture for clinical risk prediction. In the first stage, a fine-tuned Large Language Model (LLM) extracts crucial, task-relevant information from clinical notes, which is enhanced by graph-based retrieval of external domain knowledge from sources such as a medical corpus like PubMed, grounding the LLM's understanding. The second stage combines both unstructured representations and features derived from the structured data to generate the final predictions. This approach supports a wide range of clinical tasks. Here, we demonstrate its effectiveness on 30-day readmission and in-hospital mortality prediction. Experimental results show that our framework achieves strong performance, with AUC scores of $0.84$ and $0.92$, respectively, despite these tasks involving severely imbalanced datasets, with positive rates ranging from approximately $4\%$ to $13\%$. Moreover, it outperforms all existing baselines and clinical practices, including established risk scoring systems. To the best of our knowledge, this is one of the first frameworks for healthcare prediction which enhances the power of an LLM-based graph-guided knowledge retrieval method by combining it with structured data for improved clinical outcome prediction.

Electronic health records (EHRs) are rich clinical data sources but complex repositories of patient data, spanning structured elements (demographics, vitals, lab results, codes), unstructured clinical notes and other modalities of data. Harnessing this heterogeneity is critical for improving patient outcomes. Recent advances in large language models (LLMs) have enabled foundation models that can learn from multiple data modalities and support clinical tasks. However, most current approaches simply serialize numeric EHR data into text, which risks losing temporal and quantitative detail. We introduce Generative Deep Patient (GDP), a multimodal foundation model that natively encodes structured EHR time-series via a CNN-Transformer encoder and fuses it with unstructured EHRs through cross-modal attention into a LLaMA-based decoder. GDP is trained in two stages: (1) generative pretraining, where it learns to produce clinical narratives from raw patient timelines while also performing masked feature prediction (MFP) and next time-step prediction (NTP) to capture temporal dynamics; and (2) multi-task fine-tuning for clinically meaningful predictions (e.g., heart failure, type 2 diabetes, 30-day readmission). In clinical prediction, GDP demonstrated superior performance on MIMIC-IV: heart failure AUROC = 0.923, type 2 diabetes AUROC = 0.817, and 30-day readmission AUROC = 0.627. For narrative generation, GDP achieved ROUGE-L = 0.135 and BERTScore-F1 = 0.545. In a blinded human evaluation, GDP-Instruct scored highest on faithfulness, fluency, and overall clinical utility, suggesting reduced hospital documentation workload without sacrificing accuracy. Our results demonstrate that a single multimodal foundation model can both predict clinically actionable events and generate high-quality clinical narratives. Furthermore, GDP's flexible architecture can be extended to additional modalities.

In medical imaging, inter-observer variability among radiologists often introduces label uncertainty, particularly in modalities where visual interpretation is subjective. Lung ultrasound (LUS) is a prime example-it frequently presents a mixture of highly ambiguous regions and clearly discernible structures, making consistent annotation challenging even for experienced clinicians. In this work, we introduce a novel approach to both labeling and training AI models using expert-supplied, per-pixel confidence values. Rather than treating annotations as absolute ground truth, we design a data annotation protocol that captures the confidence that radiologists have in each labeled region, modeling the inherent aleatoric uncertainty present in real-world clinical data. We demonstrate that incorporating these confidence values during training leads to improved segmentation performance. More importantly, we show that this enhanced segmentation quality translates into better performance on downstream clinically-critical tasks-specifically, estimating S/F oxygenation ratio values, classifying S/F ratio change, and predicting 30-day patient readmission. While we empirically evaluate many methods for exposing the uncertainty to the learning model, we find that a simple approach that trains a model on binarized labels obtained with a (60%) confidence threshold works well. Importantly, high thresholds work far better than a naive approach of a 50% threshold, indicating that training on very confident pixels is far more effective. Our study systematically investigates the impact of training with varying confidence thresholds, comparing not only segmentation metrics but also downstream clinical outcomes. These results suggest that label confidence is a valuable signal that, when properly leveraged, can significantly enhance the reliability and clinical utility of AI in medical imaging.

Transitional care may play a vital role for the sustainability of Europe future healthcare system, offering solutions for relocating patient care from hospital to home therefore addressing the growing demand for medical care as the population is ageing. However, to be effective, it is essential to integrate innovative Information and Communications Technology technologies to ensure that patients with comorbidities experience a smooth and coordinated transition from hospitals or care centers to home, thereby reducing the risk of rehospitalization. In this paper, we present an overview of the integration of Internet of Things, artificial intelligence, and digital assistance technologies with traditional care pathways to address the challenges and needs of healthcare systems in Europe. We identify the current gaps in transitional care and define the technology mapping to enhance the care pathways, aiming to improve patient outcomes, safety, and quality of life avoiding hospital readmissions. Finally, we define the trial setup and evaluation methodology needed to provide clinical evidence that supports the positive impact of technology integration on patient care and discuss the potential effects on the healthcare system.