AI Tools Show Promise for Improving Diagnostics and Outcome Prediction in Resource-Limited Health Care Settings

Key Takeaways: 

• Transfer learning enables AI models trained in data-rich settings to be safely adapted for use in health care systems with limited local data, improving predictive performance without rebuilding models from scratch.
• In a Vietnam case study, an adapted AI model substantially improved prediction of neurological recovery after cardiac arrest compared with the unadapted model.
• Wider adoption of AI in low- and middle-income countries will require targeted skills development, infrastructure support and robust global governance frameworks.
  
  
  

Reducing uncertainty after cardiac arrest in constrained settings

After a cardiac arrest, families and clinicians are often confronted with profound uncertainty about a person’s chances of neurological recovery. This uncertainty is particularly acute in hospitals with limited resources, where access to advanced diagnostics and large datasets is constrained.

Researchers from Duke-NUS Medical School and collaborators have demonstrated how artificial intelligence can help address this challenge. By adapting an advanced AI model, the team improved the accuracy of neurological outcome prediction following cardiac arrest in a resource-limited setting.

Published in npj Digital Medicine, the study focused on the use of transfer learning, an AI technique that adapts models pre-trained on large datasets to new environments with limited local data. This approach can enhance performance in new contexts without requiring extensive and costly data collection, making it particularly relevant for low- and middle-income countries.

Adapting a high-income model for local use

The researchers began with a brain-recovery prediction model developed in Japan using data from 46,918 people who experienced out-of-hospital cardiac arrest. They then adapted this model for use in Vietnam, where it was tested on a smaller cohort of 243 patients.

The adapted model performed markedly better than the original model when applied directly to the Vietnamese data. It correctly distinguished between people at higher and lower risk of poor neurological outcomes approximately 80 percent of the time, compared with around 46 percent accuracy when the original, unadapted model was used.

Senior author Associate Professor Liu Nan, from Duke-NUS’ Center for Biomedical Data Science and Director of the Duke-NUS AI + Medical Sciences Initiative, said,

“The study shows AI models do not need to be rebuilt from scratch for every new setting. By adapting existing tools safely and effectively, transfer learning can lower costs, reduce development time and help extend the benefits of AI to health care systems with fewer resources.”

Expanding AI’s role beyond outcome prediction

Beyond predicting outcomes after cardiac arrest, AI has potential applications across a broad range of health care needs in low- and middle-income countries. In a separate study published in Nature Health, Duke-NUS researchers and collaborators, including colleagues from University College London, explored how large language models, trained on extensive text data to understand and generate human language, could support global health.

In resource-constrained environments, such tools may improve access to care, diagnostics and clinical decision-making. Examples highlighted by the researchers included a chatbot providing pregnancy-related information to expectant mothers in South Africa and smartphone-based applications used by community health workers in Sierra Leone to detect malaria infections from blood smear samples. These approaches offer more cost-efficient alternatives to conventional microscope-based systems.

Despite these advances, the researchers noted that AI development and deployment remain concentrated in high-income and upper-middle-income settings. While 63 percent of surveyed researchers, clinicians and service providers reported actively using AI tools, many low- and middle-income countries continue to face significant barriers, including limited infrastructure, insufficient technical expertise and a lack of locally generated evidence on how best to address these gaps.

Co-author Siegfried Wagner, from UCL Institute of Ophthalmology and Moorfields Eye Hospital NHS Foundation Trust, said,

“LLMs have the greatest opportunity to transform health care in settings where specialist physicians are scarcest, but the global health community needs to work together with some urgency to ensure the implementation of LLMs is supported in regions where adoption is most challenging.”

Dr Ning Yilin, Senior Research Fellow at Duke-NUS’ Center for Biomedical Data Science and a co-first author of the study, emphasised the importance of prioritising people when integrating AI into health care:

“Strengthening digital literacy and building confidence in using these tools will ensure AI supports, rather than disrupts, the workforce. Tailored skills-development pathways can help under-resourced workers adapt and thrive, allowing AI to uplift and add value to clinical and administrative roles.”

Charting the path forward: Governance and guardrails

While AI tools have clear potential to improve health care delivery, the researchers stressed that appropriate governance frameworks are essential to ensure safe and ethical implementation. Existing regulations for medical technologies often do not adequately address AI-specific risks, such as data privacy concerns, model hallucinations or unclear accountability for deployment and oversight.

To help close these gaps, researchers led by Duke-NUS have proposed the creation of an international consortium known as the Partnership for Oversight, Leadership, and Accountability in Regulating Intelligent Systems-Generative Models in Medicine, or POLARIS-GM.

The consortium aims to develop actionable best-practice guidance for regulating emerging AI tools, monitoring their impact, establishing safety guardrails and adapting them for use in resource-limited settings. By bringing together health care leaders, regulators, ethicists and patient groups from around the world, POLARIS-GM plans to adopt a phased approach, beginning with a review of existing research before working towards global consensus on AI governance in health care.

Dr Jasmine Ong, from the Duke-NUS AI + Medical Sciences Initiative and a Principal Clinical Pharmacist at Singapore General Hospital, and first author of the correspondence published in Nature Medicine, said,

“With clear oversight and clearly defined guidelines, health care systems can confidently leverage AI’s many strengths to improve health outcomes while steering clear of potential pitfalls.

From policymakers to patient groups, all stakeholders have a crucial role to play in making this goal a reality.”