Local Instrumental Variable Methods to Address Confounding and Heterogeneity when Using Electronic Health Records: An Application to Emergency Surgery.
Silvia Moler-ZapataRichard D GrieveDavid Lugo-PalaciosA HutchingsR SilverwoodLuke KeeleTommaso KircheisDavid CromwellNeil SmartRobert HinchliffeStephen O'NeillPublished in: Medical decision making : an international journal of the Society for Medical Decision Making (2022)
This article addresses the confounding and heterogeneity that arise when assessing the comparative effectiveness from electronic health records (EHR) data, by applying a local instrumental variable (LIV) approach to evaluate the cost-effectiveness of emergency surgery (ES) versus alternative strategies, for patients with common acute conditions (appendicitis, diverticular disease, and abdominal wall hernia).The instrumental variable, the hospital's tendency to operate, was found to be strongly associated with ES receipt and to minimize imbalances in baseline characteristics between the comparison groups.The LIV approach found that, for each condition, there was heterogeneity in the estimates of cost-effectiveness according to baseline characteristics.The study illustrates how an LIV approach can be applied to EHR data to provide cost-effectiveness estimates that recognize heterogeneity and can be used to inform decision making as well as to generate hypotheses for further research.
Keyphrases
- electronic health record
- single cell
- adverse drug
- clinical decision support
- minimally invasive
- healthcare
- coronary artery bypass
- decision making
- emergency department
- public health
- liver failure
- respiratory failure
- drug induced
- machine learning
- acute coronary syndrome
- percutaneous coronary intervention
- clinical evaluation