{"id":"https://openalex.org/W7223185181","doi":"https://doi.org/10.7759/cureus.118344","title":"Case Mix and Protocol Constraints in Diagnostic Language Model Conversations: A Secondary Analysis of Released MedR-Bench Outputs","display_name":"Case Mix and Protocol Constraints in Diagnostic Language Model Conversations: A Secondary Analysis of Released MedR-Bench Outputs","publication_year":2026,"publication_date":"2026-10-21","ids":{"openalex":"https://openalex.org/W7223185181","doi":"https://doi.org/10.7759/cureus.118344","pmid":"https://pubmed.ncbi.nlm.nih.gov/42923802","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13688003"},"language":"en","primary_location":{"id":"doi:10.7759/cureus.118344","doi":"https://doi.org/10.7759/cureus.118344","is_oa":true,"landing_page_url":"https://doi.org/10.7759/cureus.118344","pdf_url":"https://www.cureus.com/articles/538657-case-mix-and-protocol-constraints-in-diagnostic-language-model-conversations-a-secondary-analysis-of-released-medr-bench-outputs.pdf","source":{"id":"https://openalex.org/S2738950867","display_name":"Cureus","issn_l":"2168-8184","issn":["2168-8184"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-20","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310316779","host_organization_name":"Cureus, Inc.","host_organization_lineage":["https://openalex.org/P4310316779"],"host_organization_lineage_names":["Cureus, Inc."],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"diamond","oa_url":"https://www.cureus.com/articles/538657-case-mix-and-protocol-constraints-in-diagnostic-language-model-conversations-a-secondary-analysis-of-released-medr-bench-outputs.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5146495609","display_name":"Oscar Mingtian Li","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Oscar Mingtian Li","raw_affiliation_strings":["Zweistein Innovation Lab, Active Care and Education in Sports and Outreach Foundation (ACESO Foundation), Dublin, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Zweistein Innovation Lab, Active Care and Education in Sports and Outreach Foundation (ACESO Foundation), Dublin, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5113076740","display_name":"Summer Xia Tian Li","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Summer Xia Tian Li","raw_affiliation_strings":["Zweistein Innovation Lab, Active Care and Education in Sports and Outreach Foundation (ACESO Foundation), Dublin, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Zweistein Innovation Lab, Active Care and Education in Sports and Outreach Foundation (ACESO Foundation), Dublin, USA","institution_ids":[]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5146553393","display_name":"Yijiang Li","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Yijiang Li","raw_affiliation_strings":["Zweistein Innovation Lab, Active Care and Education in Sports and Outreach Foundation (ACESO Foundation), Dublin, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Zweistein Innovation Lab, Active Care and Education in Sports and Outreach Foundation (ACESO Foundation), Dublin, USA","institution_ids":[]}]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":["https://openalex.org/A5146495609"],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.70460519,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"18","issue":"10","first_page":"e118344","last_page":"e118344"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11636","display_name":"Artificial Intelligence in Healthcare and Education","score":0.9404000043869019,"subfield":{"id":"https://openalex.org/subfields/2718","display_name":"Health Informatics"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11636","display_name":"Artificial Intelligence in Healthcare and Education","score":0.9404000043869019,"subfield":{"id":"https://openalex.org/subfields/2718","display_name":"Health Informatics"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12574","display_name":"Clinical Reasoning and Diagnostic Skills","score":0.025100000202655792,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13702","display_name":"Machine Learning in Healthcare","score":0.01209999993443489,"subfield":{"id":"https://openalex.org/subfields/1702","display_name":"Artificial Intelligence"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/diagnostic-reasoning","display_name":"diagnostic reasoning","score":0.3479999899864197},{"id":"https://openalex.org/keywords/case-mix","display_name":"case mix","score":0.41999998688697815},{"id":"https://openalex.org/keywords/missing-information","display_name":"missing information","score":0.38100001215934753},{"id":"https://openalex.org/keywords/diagnostic-trajectories","display_name":"diagnostic trajectories","score":0.4869999885559082},{"id":"https://openalex.org/keywords/ai-assisted-diagnosis","display_name":"AI-assisted diagnosis","score":0.43299999833106995},{"id":"https://openalex.org/keywords/bootstrap-method","display_name":"bootstrapping","score":0.5419999957084656},{"id":"https://openalex.org/keywords/linear-probability-model","display_name":"linear probability model","score":0.492000013589859}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8884000182151794},{"id":"https://openalex.org/C88579808","wikidata":"https://www.wikidata.org/wiki/Q1046955","display_name":"Case mix index","level":2,"score":0.7009000182151794},{"id":"https://openalex.org/C2780385302","wikidata":"https://www.wikidata.org/wiki/Q367158","display_name":"Protocol (science)","level":3,"score":0.6801000237464905},{"id":"https://openalex.org/C137293760","wikidata":"https://www.wikidata.org/wiki/Q3621696","display_name":"Language model","level":2,"score":0.3813999891281128},{"id":"https://openalex.org/C204321447","wikidata":"https://www.wikidata.org/wiki/Q30642","display_name":"Natural language processing","level":1,"score":0.35569998621940613},{"id":"https://openalex.org/C59050026","wikidata":"https://www.wikidata.org/wiki/Q5048330","display_name":"Case analysis","level":2,"score":0.334199994802475},{"id":"https://openalex.org/C2777620637","wikidata":"https://www.wikidata.org/wiki/Q7535191","display_name":"Skill mix","level":3,"score":0.3034000098705292},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.29440000653266907},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.24609999358654022},{"id":"https://openalex.org/C179603123","wikidata":"https://www.wikidata.org/wiki/Q1941921","display_name":"Modeling language","level":3,"score":0.23260000348091125}],"mesh":[],"locations_count":3,"locations":[{"id":"doi:10.7759/cureus.118344","doi":"https://doi.org/10.7759/cureus.118344","is_oa":true,"landing_page_url":"https://doi.org/10.7759/cureus.118344","pdf_url":"https://www.cureus.com/articles/538657-case-mix-and-protocol-constraints-in-diagnostic-language-model-conversations-a-secondary-analysis-of-released-medr-bench-outputs.pdf","source":{"id":"https://openalex.org/S2738950867","display_name":"Cureus","issn_l":"2168-8184","issn":["2168-8184"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-20","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310316779","host_organization_name":"Cureus, Inc.","host_organization_lineage":["https://openalex.org/P4310316779"],"host_organization_lineage_names":["Cureus, Inc."],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13688003","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13688003/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13688003/pdf/cureus-0018-00000118344.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"Text"},{"id":"pmid:42923802","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42923802","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"Journal Article"}],"best_oa_location":{"id":"doi:10.7759/cureus.118344","doi":"https://doi.org/10.7759/cureus.118344","is_oa":true,"landing_page_url":"https://doi.org/10.7759/cureus.118344","pdf_url":"https://www.cureus.com/articles/538657-case-mix-and-protocol-constraints-in-diagnostic-language-model-conversations-a-secondary-analysis-of-released-medr-bench-outputs.pdf","source":{"id":"https://openalex.org/S2738950867","display_name":"Cureus","issn_l":"2168-8184","issn":["2168-8184"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-20","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310316779","host_organization_name":"Cureus, Inc.","host_organization_lineage":["https://openalex.org/P4310316779"],"host_organization_lineage_names":["Cureus, Inc."],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"journal-article"},"sustainable_development_goals":[{"score":0.6240000128746033,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7223185181.pdf","grobid_xml":"https://content.openalex.org/works/W7223185181.grobid-xml"},"referenced_works_count":10,"referenced_works":["https://openalex.org/W4402029659","https://openalex.org/W4402846493","https://openalex.org/W4406152263","https://openalex.org/W4415956903","https://openalex.org/W4417175683","https://openalex.org/W7156104865","https://openalex.org/W7161600910","https://openalex.org/W7171662339","https://openalex.org/W7172541510","https://openalex.org/W7202202844"],"related_works":["https://openalex.org/W7215067459","https://openalex.org/W7167622529","https://openalex.org/W7162131674","https://openalex.org/W7171658785","https://openalex.org/W4413481664","https://openalex.org/W4417175683","https://openalex.org/W7203738330","https://openalex.org/W7166837171","https://openalex.org/W7151226796","https://openalex.org/W4402670852"],"abstract_inverted_index":{"Introduction":[0],"Diagnostic":[1],"language":[2],"models":[3,141],"can":[4],"request":[5,272],"additional":[6],"examinations":[7],"before":[8],"answering.":[9],"Their":[10],"observed":[11],"stopping":[12],"behavior":[13],"depends":[14],"on":[15],"the":[16,18,25,80,94,115,118,171,231,234,243,298],"model,":[17],"information":[19,90,105,342],"returned":[20,198],"by":[21,183,308],"a":[22,55,77,101,212,337],"simulator,":[23],"and":[24,28,49,70,145,148,152,156,168,193,261,264,277,302,311,321],"interaction":[26,57],"protocol,":[27],"these":[29,196],"contributions":[30],"are":[31,330],"difficult":[32],"to":[33,178,225,257,268,314],"separate":[34],"in":[35,46,93,188,283],"aggregate":[36],"benchmark":[37],"results.":[38],"We":[39,60],"quantified":[40],"an":[41],"explicit":[42],"unavailable-information":[43,299],"text":[44,78,200,300],"marker":[45,186,280,301],"simulator":[47,82,96],"feedback":[48],"its":[50],"association":[51,296],"with":[52,127,131,142,151,233,249,259],"fifth-response":[53,111,209,303],"contact,":[54,112],"protocol-imposed":[56],"limit.":[58],"Methods":[59],"analyzed":[61],"released":[62,181],"MedR-Bench":[63],"diagnosis":[64],"conversations":[65],"from":[66,176],"seven":[67],"model":[68,129,143,149,232,250,262],"labels":[69],"957":[71],"source":[72,317],"case":[73,241,291,309],"reports.":[74,318],"Exposure":[75],"was":[76,91,99,106,110,218,246,305,312],"marker:":[79],"exact":[81],"sentence":[83],"stating":[84],"that":[85,104,114],"no":[86],"relevant":[87],"ancillary":[88],"test":[89],"available,":[92],"first":[95,190],"feedback.":[97],"It":[98],"not":[100,335],"clinical":[102,346],"judgment":[103],"missing.":[107],"The":[108,185,215,237,294],"outcome":[109],"meaning":[113],"run":[116],"reached":[117],"fifth":[119],"assistant":[120],"response.":[121],"Within-model":[122],"risk":[123],"differences":[124],"were":[125,166],"averaged":[126],"equal":[128],"weights,":[130],"5,000":[132],"report-cluster":[133],"bootstrap":[134],"resamples.":[135],"Sensitivity":[136],"analyses":[137],"used":[138],"linear":[139],"probability":[140],"effects":[144],"then":[146],"report":[147,260],"effects,":[150,251,263],"without":[153,230],"first-request":[154],"composition,":[155],"leave-one-model-out":[157],"summaries.":[158],"Results":[159],"Of":[160],"6,699":[161],"expected":[162],"report-model":[163],"cells,":[164],"6,690":[165],"released,":[167],"5,719":[169],"entered":[170],"first-feedback":[172],"analysis;":[173],"entry":[174],"ranged":[175],"41.2%":[177],"98.0%":[179],"of":[180,195,285,340],"runs":[182,210],"model.":[184],"appeared":[187],"4,593":[189],"feedbacks":[191],"(80.3%),":[192],"96.2%":[194],"also":[197],"other":[199],"for":[201],"at":[202],"least":[203],"one":[204],"requested":[205],"item.":[206],"All":[207],"1,001":[208],"followed":[211],"mandatory-final-answer":[213],"prompt.":[214],"equal-model-weighted":[216],"difference":[217,238],"6.37":[219],"percentage":[220],"points":[221,229,248,253,266],"(95%":[222,254],"CI":[223,255],"4.16":[224,228],"8.54),":[226],"or":[227,343],"largest":[235],"difference.":[236],"largely":[239,306],"reflected":[240],"composition:":[242],"common-slope":[244],"coefficient":[245],"5.61":[247],"1.05":[252],"-1.64":[256],"3.74)":[258],"1.21":[265],"(-1.67":[267],"4.08)":[269],"after":[270],"adding":[271],"composition.":[273],"In":[274],"paired":[275],"one-round":[276],"free-turn":[278],"releases,":[279],"status":[281],"differed":[282],"1,309":[284],"5,701":[286],"pairs":[287],"(23.0%)":[288],"despite":[289],"identical":[290],"text.":[292],"Conclusions":[293],"positive":[295],"between":[297],"contact":[304],"explained":[307],"composition":[310,320],"close":[313],"null":[315],"within":[316],"Case":[319],"protocol":[322],"states":[323],"should":[324],"remain":[325],"visible":[326],"when":[327],"diagnostic":[328],"trajectories":[329],"evaluated.":[331],"These":[332],"data":[333],"do":[334],"establish":[336],"causal":[338],"effect":[339],"missing":[341],"support":[344],"heart-failure":[345],"validation.":[347]},"counts_by_year":[],"updated_date":"2026-11-08T12:12:28.789561","created_date":"2026-10-22T00:00:00"}