期刊
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
卷 52, 期 3, 页码 827-836出版社
OXFORD UNIV PRESS
DOI: 10.1093/ije/dyac185
关键词
Randomized controlled trial; electronic medical record; Bayesian modelling; dementia; cognition; acetylcholinesterase inhibitors
This study proposes a novel method that combines electronic medical records and randomized controlled trials to analyze treatment effectiveness. The results demonstrate that this approach provides more accurate estimates of treatment effects.
Background Health care professionals seek information about effectiveness of treatments in patients who would be offered them in routine clinical practice. Electronic medical records (EMRs) and randomized controlled trials (RCTs) can both provide data on treatment effects; however, each data source has limitations when considered in isolation. Methods A novel modelling methodology which incorporates RCT estimates in the analysis of EMR data via informative prior distributions is proposed. A Bayesian mixed modelling approach is used to model outcome trajectories among patients in the EMR dataset receiving the treatment of interest. This model incorporates an estimate of treatment effect based on a meta-analysis of RCTs as an informative prior distribution. This provides a combined estimate of treatment effect based on both data sources. Results The superior performance of the novel combined estimator is demonstrated via a simulation study. The new approach is applied to estimate the effectiveness at 12 months after treatment initiation of acetylcholinesterase inhibitors in the management of the cognitive symptoms of dementia in terms of Mini-Mental State Examination scores. This demonstrated that estimates based on either trials data only (1.10, SE = 0.316) or cohort data only (1.56, SE = 0.240) overestimated this compared with the estimate using data from both sources (0.86, SE = 0.327). Conclusions It is possible to combine data from EMRs and RCTs in order to provide better estimates of treatment effectiveness.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据