2024/10/15 by Panayiotis Petousis, David Gordon, Petousis, Panayiotis +5
Economics, Econometrics and Finance · #FOS: Computer and information sciences #Health Systems, Economic Evaluations, Quality of Life #Machine Learning (cs.LG) #Methodology (stat.ME)
paper · pdf · doi:10.48550/arxiv.2410.12047
openalex publication_date 2024/10/15 · openalex created_date 2024/10/20 · openalex updated_date 2026/07/28
Randomized controlled trials (RCTs) are the standard for evaluating the effectiveness of clinical interventions. To address the limitations of RCTs on real-world populations, we developed a methodology that uses a large observational electronic health record (EHR) dataset. Principles of regression discontinuity (rd) were used to derive randomized data subsets to test expert-driven interventions using dynamic Bayesian Networks (DBNs) do-operations. This combined method was applied to a chronic kidney disease (CKD) cohort of more than two million individuals and used to understand the associational and causal relationships of CKD variables with respect to a surrogate outcome of >=40% decline in estimated glomerular filtration rate (eGFR). The associational and causal analyses depicted similar findings across DBNs from two independent healthcare systems. The associational analysis showed that the most influential variables were eGFR, urine albumin-to-creatinine ratio, and pulse pressure, whereas the causal analysis showed eGFR as the most influential variable, followed by modifiable factors such as medications that may impact kidney function over time. This methodology demonstrates how real-world EHR data can be used to provide population-level insights to inform improved healthcare delivery.