Association Between Large Language Model-Derived Mobility Functional Status Assessment and Clinical Outcomes.
TL;DR
LLM-derived mobility functional status assessment was associated with ED visits and hospitalization, but not with all-cause mortality after adjustment, and prospective validation and evaluation of incremental discrimination, calibration, and clinical utility are needed before clinical implementation.
Abstract
Background
Mobility functional status is inconsistently recorded in electronic health records. Recent advances in Large Language Models (LLMs) enable automated extraction of functional information from unstructured clinical notes. Leveraging a validated functional LLM with high performance in mobility extraction, we aimed to study the association between LLM-derived mobility functional status and clinical outcomes, including emergency department (ED) visits, hospitalizations, and mortality.
Methods
Individuals aged 60 years and older enrolled in the Mayo Clinic Study of Aging, with documented clinical notes in 2022 were included. Individuals without any identifiable functional information were excluded. The LLM-derived mobility functional status categorized mobility as impaired or unimpaired, across the five mobility domains as classified by International Classification of Functioning, Disability, and Health. Clinical outcomes in 2023 were extracted from the Rochester Epidemiology Project database. Logistic regression models assessed associations between mobility impairment and outcomes, adjusted for age, sex, Elixhauser comorbidity index, and education.
Results
Three thousand three hundred thirty-seven individuals were screened, of whom three hundred forty-three had no functional information. Two thousand nine hundred ninety-four individuals were analyzed. 79.4% had at least one mobility impairment. Higher mobility impairment is associated with older age and greater Elixhauser comorbidity. Individuals with 3 or more impairments had an increased adjusted odds of ED visits (Adjusted Odds Ratio (aOR): 2.18 (1.64, 2.90)) and hospitalizations (aOR: 2.35 (1.51, 3.65)) compared to unimpaired individuals (p < 0.001), while mortality did not demonstrate a significant association with mobility impairment.
Conclusion
LLM-derived mobility functional status assessment was associated with ED visits and hospitalization, but not with all-cause mortality after adjustment. Prospective validation and evaluation of incremental discrimination, calibration, and clinical utility are needed before clinical implementation.