Alissa A. Valentine

Isotta Landi, Eugenia Alleva, Alissa A. Valentine et al.

Despite being a unique source of information on patients' status and disease progression, clinical notes are characterized by high levels of duplication and information redundancy. In general domain text, it has been shown that deduplication does not harm language model (LM) pretraining, thus helping reduce the training cost. Although large LMs have proven to learn medical knowledge, they still require specialized domain adaptation for improved downstream clinical tasks. By leveraging large real-world clinical corpora, we first provided a fine-grained characterization of duplicates stemming from common writing practices and clinical relevancy. Second, we demonstrated that deduplicating clinical text can help clinical LMs encode less redundant information in a more efficient manner and do not harm classification tasks via prompt-based learning.

Alissa A. Valentine, Lauren A. Lepow, Lili Chan et al.

In the United States, schizophrenia (SCZ) carries a race and sex disparity that may be explained by clinician bias - a belief held by a clinician about a patient that prevents impartial clinical decision making. The emergency department (ED) is marked by higher rates of stress that lead to clinicians relying more on implicit biases during decision making. In this work, we considered a large cohort of psychiatric patients in the ED from the Mount Sinai Health System (MSHS) in New York City to investigate the effects of clinician bias on SCZ diagnosis while controlling for known risk factors and patient sociodemographic information. Clinician bias was quantified as the ratio of negative to total sentences within a patient's first ED note. We utilized a logistic regression to predict SCZ diagnosis given patient race, sex, age, history of trauma or substance use disorder, and the ratio of negative sentences. Our findings showed that an increased ratio of negative sentences is associated with higher odds of obtaining a SCZ diagnosis [OR (95% CI)=1.408 (1.361-1.456)]. Identifying as male [OR (95% CI)=1.112 (1.055-1.173)] or Black [OR (95% CI)=1.081(1.031-1.133)] increased one's odds of being diagnosed with SCZ. However, from an intersectional lens, Black female patients with high SES have the highest odds of obtaining a SCZ diagnosis [OR (95% CI)=1.629 (1.535-1.729)]. Results such as these suggest that SES does not act as a protective buffer against SCZ diagnosis in all patients, demanding more attention to the quantification of health disparities. Lastly, we demonstrated that clinician bias is operational with real world data and related to increased odds of obtaining a stigmatizing diagnosis such as SCZ.