Low-resource classification of mobility functioning information in clinical sentences using large language models

Objective: Function is increasingly recognized as an important indicator of whole-person health. This study evaluates the ability of publicly available LLMs to accurately identify the presence of functioning information from clinical notes. We explore various strategies to improve the performance on this task. Materials and Methods: We collect a balanced binary classification dataset of 1000 sentences from the Mobility NER dataset, which was curated from n2c2 clinical notes. For evaluation, we construct zero-shot and few-shot prompts to query the LLMs whether a given sentence contains mobility functioning information. Two sampling techniques, random sampling and k-nearest neighbor (kNN)-based sampling, are used to select the few-shot examples. Furthermore, we apply a parameter-efficient prompt-based fine-tuning method to the LLMs and evaluate their performance under various training settings. Results: Flan-T5-xxl outperforms all other models in both zero-shot and few-shot settings, achieving a F1 score of 0.865 with a single demonstrative example selected by kNN sampling. In prompt-based fine-tuning experiments, this foundation model also demonstrates superior performance across all low-resource settings, particularly achieving an impressive F1 score of 0.922 using the full training dataset. The smaller model, Flan-T5-xl, requires fine-tuning with only 2.3M additional parameters to achieve comparable performance to the fully fine-tuned Gatortron-base model, both surpassing 0.9 F1 score. Conclusion: Open-source instruction-tuned LLMs demonstrate impressive in-context learning capability in the mobility functioning classification task. The performance of these models can be further improved by continuing fine-tuning on a task-specific dataset.