AI-driven Optimisation of Quality of Recovery (QoR) in Remote Patient Monitoring
Authors: Yansong Liu, Li-Hsi, Lin, Pramit Khetrapal, Ronnie Stafford, John Kelly, Ivana Drobnjak
Organizations: Sonny
Abstract
Remote patient monitoring depends on patient-reported data to capture the subjective dimension of recovery that devices cannot measure. The Quality of Recovery (QoR-15) survey is the gold-standard instrument for this purpose. It was designed and validated for occasional in-hospital assessment, yet remote monitoring now administers it to patients daily. In our own post-surgical deployment, only 55% of patients submitted the survey more than 14 days of 30 monitoring days. We developed QoR-compact, a five-item daily input for the RPM prediction pathway. Setting a deployment-driven target of one-third of the daily items, we exhaustively evaluated all 3,003 five-question subsets of the QoR-15 and tested whether the best of them matches the full instrument in predicting near-term postoperative recovery severity. QoR-compact achieves a mean AUC-ROC of 0.968 (95% CI 0.915-0.988), statistically comparable to the 0.964 baseline obtained with one-third of the items. Patient-level backtesting indicates that it tracks readmission events as faithfully as the full form. Its five items span the physical and psychological axes of recovery: Q3 (feeling rested), Q9 (feeling comfortable and in control), Q10 (general well-being), Q12 (severe pain), and Q14 (feeling worried or anxious). The QoR-15 remains the gold-standard measure of recovery; QoR-compact complements it as a shorter daily input designed for prediction. This parity provides the basis for a prospective study of whether a lighter daily input is, in turn, completed more consistently. External validation on larger cohorts is required before clinical use.
Rehabilitation scoring systems are most useful when their outputs can be reviewed and interpreted within clinical workflows. This study presents PhaseAware, a compact framework for continuous rehabilitation quality assessment that combines a temporal backbone with phase- and body-group descriptors through a backbone-conditioned gated residual pathway. The model was evaluated on the UI-PRMD deep-squat protocol and further tested on the KIMORE squatting subset. On UI-PRMD, PhaseAware achieved an RMSE of 0.0230, corresponding to an 88.9% reduction relative to the accepted baseline. It also maintained favorable performance on KIMORE, suggesting that the phase-aware design transfers across related squatting protocols. In addition to score prediction, PhaseAware generates structured review cues based on phase- and body-level sensitivity, highlighting the movement stages and body regions most relevant to each prediction. The architecture employs a backbone-conditioned gated residual mechanism to stabilize feature representation, supporting use in resource-constrained settings. These cues are intended to support clinician review, boundary-case monitoring, and human-in-the-loop triage rather than autonomous decision-making. Overall, PhaseAware offers a practical and interpretable approach to rehabilitation scoring that may help integrate automated assessment into information systems while preserving clinician oversight.
Many clinical prediction models treat post-intervention outcomes as a one-step mapping from baseline measurements to a future endpoint. However, recovery after a procedure often unfolds as an irregular trajectory: clinical observations, medication changes, repeat interventions, and physiological measurements are recorded asynchronously and can change risk assessment over time. We propose an intervention-aware clinical world model that represents each patient with a structured latent state and evolves it through time-ordered post-intervention events. The model first encodes baseline imaging into a 3D spatial latent state. It then updates this state using procedural context, static covariates, elapsed time, and peri-event physiological embeddings. Follow-up imaging provides training-only supervision through a latent forecasting objective. We apply the framework to atrial fibrillation ablation. During the 90-day recovery window, irregular post-procedure records provide clinically meaningful evidence for long-term recurrence risk. In repeated internal cross-validation on DECAAF-II, our model achieves AUROC 0.756 and AUPRC 0.777 for recurrence prediction. It also achieves a scar-extent MAE of 2.971 percentage points without requiring follow-up MRI intensities at inference. The learned state supports recurrence-risk queries at different horizons and retrospective input editing of blanking-period records.
Electronic health records (EHRs) may incompletely capture patient-reported factors associated with opioid use disorder (OUD). We evaluated whether survey data improve prediction of a first recorded OUD diagnosis among 267,747 All of Us participants with documented opioid exposure, including 15,287 OUD cases. We compared EHR-only and EHR+survey models across 6-, 12-, and 24-month look-back windows using logistic regression, random forest, XGBoost, LightGBM, multilayer perceptron, LSTM, GRU, and Transformer. Survey augmentation improved PR-AUC across all 24 model-window combinations by 0.0087-0.0505; the best 24-month LightGBM model improved from 0.6219 to 0.6603. Survey coverage increased with longer windows and differed by OUD status (24 months: 21.7% OUD-positive vs. 60.7% OUD-negative). Permutation analysis ranked survey features as the second most important information domain at 24 months in both evaluated models. Patient-reported data provide complementary predictive signals beyond structured EHRs while highlighting the importance of survey availability.