Ha Na Cho

Ha Na Cho, Sairam Sutari, Alexander Lopez et al.

Timely discharge prediction is essential for optimizing bed turnover and resource allocation in elective spine surgery units. This study evaluates the feasibility of lightweight, fine-tuned large language models (LLMs) and traditional text-based models for predicting next-day discharge using postoperative clinical notes. We compared 13 models, including TF-IDF with XGBoost and LGBM, and compact LLMs (DistilGPT-2, Bio_ClinicalBERT) fine-tuned via LoRA. TF-IDF with LGBM achieved the best balance, with an F1-score of 0.47 for the discharge class, a recall of 0.51, and the highest AUC-ROC (0.80). While LoRA improved recall in DistilGPT2, overall transformer-based and generative models underperformed. These findings suggest interpretable, resource-efficient models may outperform compact LLMs in real-world, imbalanced clinical prediction tasks.

Ha Na Cho, Yawen Guo, Sairam Sutari et al.

Ambient AI generates draft clinical notes from patient-clinician conversations, often using lay or consumer-oriented phrasing to support patient understanding instead of standardized clinical terminology. How clinicians revise these drafts for professional documentation conventions remains unclear. We quantified clinician editing for consumer-to- clinical normalization using a dictionary-confirmed transformation framework. We analyzed 71,173 AI-draft and finalized-note section pairs from 34,726 encounters. Confirmed transformations were defined as replacing a consumer expression with its dictionary-mapped clinical equivalent in the same section. Editing significantly reduced terminology density across all sections (p < 0.001). The Assessment and Plan accounted for the largest transformation volume (59.3%). Our analysis identified 7,576 transformation events across 4,114 note sections (5.8%), representing 1.2% consumer-term deletions. Transformation intensity varied across individual clinicians (p < 0.001). Overall, clinician post-editing demonstrates consistent shifts from conversational phrasing toward standardized, section- appropriate clinical terminology, supporting section-aware ambient AI design.

Ha Na Cho, Daniel Eisenberg, Cheryl King et al.

Mental health challenges among young adults, are on the rise, necessitating effective solutions such as digital mental health interventions (DMHIs). Despite their promise, DMHIs face significant adoption barriers, including low initial uptake and high dropout rates. This study leverages machine learning (ML) to analyze behavioral patterns of users of a DMHI, eBridge, designed to increase the utilization of professional mental health services among at-risk college students through motivational interviewing-based online counseling. Our ensemble model, EngageTriBoost, achieved up to 84% accuracy in predicting engagement, measured by sign-ins and counselor interactions. We then applied the Shapley Additive exPlanations (SHAP) analysis which provided clear, interpretable insights into key factors influencing user engagement such as emotional dysregulation and perceived stigma, highlighting their critical effect on DMHI adoption. This study demonstrates the power of explainable ML for better understanding user engagement with DMHI to improve their adoption and achievable impact on mental health outcomes.

Ha Na Cho

Single-agent large language model (LLM) systems struggle to simultaneously support diverse conversational functions and maintain safety in behavioral health communication. We propose a safety-aware, role-orchestrated multi-agent LLM framework designed to simulate supportive behavioral health dialogue through coordinated, role-differentiated agents. Conversational responsibilities are decomposed across specialized agents, including empathy-focused, action-oriented, and supervisory roles, while a prompt-based controller dynamically activates relevant agents and enforces continuous safety auditing. Using semi-structured interview transcripts from the DAIC-WOZ corpus, we evaluate the framework with scalable proxy metrics capturing structural quality, functional diversity, and computational characteristics. Results illustrate clear role differentiation, coherent inter-agent coordination, and predictable trade-offs between modular orchestration, safety oversight, and response latency when compared to a single-agent baseline. This work emphasizes system design, interpretability, and safety, positioning the framework as a simulation and analysis tool for behavioral health informatics and decision-support research rather than a clinical intervention.

Ha Na Cho, Sairam Sutari, Alexander Lopez et al.

Objective: To develop and evaluate machine learning (ML) models for predicting length of stay (LOS) in elective spine surgery, with a focus on the benefits of temporal modeling and model interpretability. Materials and Methods: We compared traditional ML models (e.g., linear regression, random forest, support vector machine (SVM), and XGBoost) with our developed model, SurgeryLSTM, a masked bidirectional long short-term memory (BiLSTM) with an attention, using structured perioperative electronic health records (EHR) data. Performance was evaluated using the coefficient of determination (R2), and key predictors were identified using explainable AI. Results: SurgeryLSTM achieved the highest predictive accuracy (R2=0.86), outperforming XGBoost (R2 = 0.85) and baseline models. The attention mechanism improved interpretability by dynamically identifying influential temporal segments within preoperative clinical sequences, allowing clinicians to trace which events or features most contributed to each LOS prediction. Key predictors of LOS included bone disorder, chronic kidney disease, and lumbar fusion identified as the most impactful predictors of LOS. Discussion: Temporal modeling with attention mechanisms significantly improves LOS prediction by capturing the sequential nature of patient data. Unlike static models, SurgeryLSTM provides both higher accuracy and greater interpretability, which are critical for clinical adoption. These results highlight the potential of integrating attention-based temporal models into hospital planning workflows. Conclusion: SurgeryLSTM presents an effective and interpretable AI solution for LOS prediction in elective spine surgery. Our findings support the integration of temporal, explainable ML approaches into clinical decision support systems to enhance discharge readiness and individualized patient care.