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Multimodal Machine Learning Model for Predicting High-Cost Hospital Episodes Using Pharmacy Utilization, Procedure Sequences, Length-of-Stay Trends, Intensive Care Transfers, and Administrative Claims Data
A small fraction of hospital episodes accounts for a disproportionate share of inpatient spending. Early recognition of these episodes remains difficult when risk assessment depends mainly on static admission information. More adaptive prediction is needed to support clinical and financial planning during hospitalization. Existing cost prediction models often emphasize claims, diagnoses, or broad utilization histories while underusing the dynamic signals that emerge during the inpatient stay. Pharmacy utilization, procedure sequencing, length-of-stay progression, and intensive care transfers may reveal escalating resource intensity before the final cost is known. Failure to integrate these modalities limits early identification of high-cost episodes. This article proposes a multimodal deep learning framework for predicting whether a hospitalization could become a high-cost outlier. The model is designed to combine pharmacy utilization, procedure sequences, length-of-stay trends, intensive care transfer events, and administrative claims data. The intended use is dynamic risk estimation early and repeatedly during the episode. The conceptual model uses separate modality-specific encoders for static claims features, temporal procedure events, pharmacy utilization patterns, length-of-stay trajectories, and intensive care transfer indicators. These representations are fused into a shared episode-level embedding trained with a cost-sensitive objective. The framework is intended for evaluation in historical and silent prospective deployment settings without assuming immediate clinical intervention effects. Conceptually, the model would output an updated probability that an active hospitalization will exceed a high-cost threshold. This probability would change as new medication orders, procedures, length-of-stay milestones, and intensive care transfers occur. The output could support utilization review, case management, pharmacy stewardship, and financial counseling workflows. A multimodal deep learning model for high-cost hospital episode prediction could help health systems identify emerging cost outliers before discharge. By combining static claims information with dynamic inpatient trajectories, such a model could support earlier resource allocation and more coordinated care planning. Its value should be assessed through careful validation, calibration, workflow integration, and prospective impact evaluation.
Journal of Health Informatics and Digital Systems
Original Research | Open access | 20 July 2024 | Article: 93

Multimodal Neural Network for Predicting Patient Complaint Escalation Using Call Center Transcripts, Portal Messages, Service Recovery Notes, Encounter Metadata, and Prior Satisfaction Survey Responses
Escalated patient complaints signal breakdowns in communication, care coordination, service recovery, and trust. These events can create safety, reputational, financial, and legal risk, yet they often emerge from data already generated before escalation occurs. Current complaint management workflows are largely reactive. Health systems often rely on manual triage, retrospective reports, and delayed recognition of risk after a patient’s dissatisfaction has already intensified. This article proposes a multimodal neural network for predicting whether an initial patient complaint is likely to escalate into a formal grievance, regulatory concern, legal threat, or other high-risk pathway. The model is conceptual and intended to support early intervention rather than replace human judgment. The proposed architecture integrates call center transcript embeddings, portal message language features, service recovery note representations, structured encounter metadata, and prior satisfaction survey responses. These inputs are fused into a dynamic escalation risk representation that could be updated as new interactions occur. Conceptually, the model would identify high-risk patterns such as repeated calls with increasing anger, portal messages expressing urgency, unresolved service recovery documentation, and prior low satisfaction scores. Such early detection could help patient relations teams prioritize timely outreach and targeted resolution. A multimodal neural network for complaint escalation prediction could shift patient relations from retrospective damage control toward proactive experience improvement. Its value would depend on careful validation, interpretability, privacy protection, and responsible integration into service recovery workflows.
Journal of Health Informatics and Digital Systems
Original Research | Open access | 25 February 2026 | Article: 119
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AI-driven Diagnostics Artificial Intelligence in Health Informatics Artificial Intelligence in Healthcare Big Data in Healthcare Clinical Data Mining Clinical Decision Support Systems Clinical Informatics Computer Vision Connected Health Systems Deep Learning Digital Health Digital Healthcare Innovation Digital Transformation in Healthcare Electronic Health Records Ethical AI in Healthcare Explainable AI Health Data Analytics Health Data Privacy Health Informatics Health Information Management Health Information Systems Health System Optimization Health Technology Assessment Healthcare Data Science Healthcare Informatics Healthcare Information Security Healthcare Management Healthcare Management Information Systems Intelligent Medical Systems Internet of Medical Things (IoMT) Interoperability in Healthcare Systems Machine Learning Medical Data Analytics Medical Data Management Medical Imaging Mobile Health (mHealth) Natural Language Processing Precision Medicine Predictive Analytics Remote Patient Monitoring Smart Healthcare Systems Telemedicine Wearable Health Technologies e-Health




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