Nong Paige, Adler-Milstein Julia, Apathy Nate C, Holmgren A Jay, Everson Jordan
Paige Nong (
Julia Adler-Milstein, University of California San Francisco, San Francisco, California.
Health Aff (Millwood). 2025 Jan;44(1):90-98. doi: 10.1377/hlthaff.2024.00842.
Effective evaluation and governance of predictive models used in health care, particularly those driven by artificial intelligence (AI) and machine learning, are needed to ensure that models are fair, appropriate, valid, effective, and safe, or FAVES. We analyzed data from the 2023 American Hospital Association Annual Survey Information Technology Supplement to identify how AI and predictive models are used and evaluated for accuracy and bias in hospitals. Hospitals use AI and predictive models to predict health trajectories or risks for inpatients, identify high-risk outpatients to inform follow-up care, monitor health, recommend treatments, simplify or automate billing procedures, and facilitate scheduling. We found that 65 percent of US hospitals used predictive models, and 79 percent of those used models from their electronic health record developer. Sixty-one percent of hospitals that used models evaluated them for accuracy using data from their health system (local evaluation), but only 44 percent reported local evaluation for bias. Hospitals that developed their own predictive models, had high operating margins, and were health system members were more likely to report local evaluation. Policy and programs that provide technical support, tools to assess FAVES principles, and educational resources would help ensure that all hospitals can use predictive models safely and prevent a new organizational digital divide in AI.
为确保预测模型公平、恰当、有效、有用且安全(即FAVES),需要对医疗保健中使用的预测模型,尤其是那些由人工智能(AI)和机器学习驱动的模型进行有效评估和治理。我们分析了2023年美国医院协会年度调查信息技术补充资料中的数据,以确定医院如何使用AI和预测模型,以及如何对其准确性和偏差进行评估。医院使用AI和预测模型来预测住院患者的健康轨迹或风险,识别高风险门诊患者以提供后续护理指导,监测健康状况,推荐治疗方案,简化或自动化计费程序,并促进日程安排。我们发现,65%的美国医院使用了预测模型,其中79%使用了来自其电子健康记录开发商的模型。使用模型的医院中,61%使用其医疗系统的数据(本地评估)对模型的准确性进行了评估,但只有44%报告对偏差进行了本地评估。开发自己的预测模型、营业利润率高且是医疗系统成员的医院更有可能报告进行了本地评估。提供技术支持、评估FAVES原则的工具和教育资源的政策和计划将有助于确保所有医院都能安全地使用预测模型,并防止在AI领域出现新的组织性数字鸿沟。