{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T02:04:23Z","timestamp":1782180263209,"version":"3.54.5"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and significance<\/jats:title>\n                    <jats:p>Acute otitis media (AOM) is a leading cause of pediatric antibiotic overuse. Safety Net Antibiotic Prescriptions (SNAPs) are recommended for antibiotic stewardship but are difficult to identify due to lack of structured documentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study validates the accuracy of Versa, a GPT-4o based HIPAA-compliant large language model (LLM), to classify AOM treatment plans from physician notes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cross-sectional study analyzed pediatric AOM encounters. Multiple prompting strategies were used to classify treatment plans and validated against a representative sample of manual reviews by 2 pediatricians. A locally fine-tuned model, Clinical-Longformer was also trained and tested against Versa and human review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 5707 encounters were included; 374 reviewed manually. Zero-shot accuracy was 97.8%; few-shot accuracy was 85%. Clinical-Longformer achieved 93.3% accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Versa effectively identifies AOM treatment plans, providing a cost-efficient quality improvement tracking tool for prescription practice patterns in pediatric antibiotic stewardship efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jamia\/ocaf170","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T12:08:10Z","timestamp":1758715690000},"page":"1947-1951","source":"Crossref","is-referenced-by-count":2,"title":["A SNAPpy use of large language models: using large language models to classify treatment plans in pediatric acute otitis media"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8438-6163","authenticated-orcid":false,"given":"Jessica J","family":"Pourian","sequence":"first","affiliation":[{"name":"Division of Clinical Informatics and Digital Transformation, Department of Pediatrics, University of California, San Francisco , San Francisco, CA 94143,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Michaels","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University of California, San Francisco , San Francisco, CA, 94143,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anh","family":"Vo","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, University of California, San Francisco , San Francisco, CA, 94143,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7939-6831","authenticated-orcid":false,"given":"A Jay","family":"Holmgren","sequence":"additional","affiliation":[{"name":"Division of Clinical Informatics and Digital Transformation, Department of Medicine, University of California, San Francisco , San Francisco, CA, 94143,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5440-1032","authenticated-orcid":false,"given":"Augusto","family":"Garcia-Agundez","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, University of California, San Francisco , San Francisco, CA, 94143,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Flaherman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, San Francisco , San Francisco, CA, 94143,","place":["United 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