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Mitchell
Conover
Author
Department of Epidemiology
Gillings School of Global Public Health
Methods for Classifying Patient Histories in Secondary Healthcare Data
In clinical safety and effectiveness research using secondary health databases, patient medical histories are typically assessed using fixed look-back approaches. Conventional applications of these approaches exclude patients who are not continuously enrolled in the database for the entire look-back period (e.g. one year), and data occurring outside this period is ignored. An alternate approach has been suggested which assesses all of the available data history, though concerns exist that results may be biased by systematic variation in the amount of available database across important study groups.
We used applied analyses as well as plasmode simulation methods to explore the application of short (1-year) and long (3-year) fixed look-backs and all-available data approaches in analyses of Medicare fee-for-service (FFS) claims data. We assessed the bias and efficiency of effect estimates when we used the different look-backs to 1) assess cohort eligibility and to 2) identify and adjust for confounders. In the applied analysis, we evaluated the effect of statin initiation (vs. non-use) on incidence of 1) cancer within six months (a negative control outcome we expected a priori to be null) and 2) all-cause mortality within two years. In the plasmode simulation, exposures (conceptually: statin initiation vs. non-initiation) and outcomes (conceptually: inpatient hospitalization) were simulated as a function of self-reported interview data obtained from the Medicare Current Beneficiary Survey (MCBS, which represented the true underlying confounder of exposure-outcome associations. We evaluated estimates after applying different look-back approaches in the linked claims data.
Compared to short fixed look-back approaches, all-available approaches selected cohorts with superior classification and produced less biased estimates. Compared to long fixed look-back approaches, all-available approaches selected more inclusive cohorts and produced more precise estimates. Though these studies were conducted in a fairly narrow (applied) setting, our findings provide real-world evidence that using all-available look-backs to classify patient histories is superior to fixed look-back approaches. Our findings provide context to investigators seeking to understand the mechanisms through which the different look-backs may produce different estimates.
Winter 2017
2017
Epidemiology
Public health
administrative claims, databases, epidemiologic methods, longitudinal studies, look-back periods, plasmode simulation
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Michele
Jonsson Funk
Thesis advisor
Til
Stürmer
Thesis advisor
Charles
Poole
Thesis advisor
Robert
Glynn
Thesis advisor
Ross
Simpson, Jr.
Thesis advisor
text
Mitchell
Conover
Creator
Department of Epidemiology
Gillings School of Global Public Health
Methods for Classifying Patient Histories in Secondary Healthcare Data
In clinical safety and effectiveness research using secondary health databases, patient medical histories are typically assessed using fixed look-back approaches. Conventional applications of these approaches exclude patients who are not continuously enrolled in the database for the entire look-back period (e.g. one year), and data occurring outside this period is ignored. An alternate approach has been suggested which assesses all of the available data history, though concerns exist that results may be biased by systematic variation in the amount of available database across important study groups.
We used applied analyses as well as plasmode simulation methods to explore the application of short (1-year) and long (3-year) fixed look-backs and all-available data approaches in analyses of Medicare fee-for-service (FFS) claims data. We assessed the bias and efficiency of effect estimates when we used the different look-backs to 1) assess cohort eligibility and to 2) identify and adjust for confounders. In the applied analysis, we evaluated the effect of statin initiation (vs. non-use) on incidence of 1) cancer within six months (a negative control outcome we expected a priori to be null) and 2) all-cause mortality within two years. In the plasmode simulation, exposures (conceptually: statin initiation vs. non-initiation) and outcomes (conceptually: inpatient hospitalization) were simulated as a function of self-reported interview data obtained from the Medicare Current Beneficiary Survey (MCBS, which represented the true underlying confounder of exposure-outcome associations. We evaluated estimates after applying different look-back approaches in the linked claims data.
Compared to short fixed look-back approaches, all-available approaches selected cohorts with superior classification and produced less biased estimates. Compared to long fixed look-back approaches, all-available approaches selected more inclusive cohorts and produced more precise estimates. Though these studies were conducted in a fairly narrow (applied) setting, our findings provide real-world evidence that using all-available look-backs to classify patient histories is superior to fixed look-back approaches. Our findings provide context to investigators seeking to understand the mechanisms through which the different look-backs may produce different estimates.
2017-12
2017
Epidemiology
Public health
administrative claims, databases, epidemiologic methods, longitudinal studies, look-back periods, plasmode simulation
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Michele
Jonsson Funk
Thesis advisor
Til
Stürmer
Thesis advisor
Charles
Poole
Thesis advisor
Robert
Glynn
Thesis advisor
Ross
Simpson, Jr.
Thesis advisor
text
Mitchell
Conover
Creator
Department of Epidemiology
Gillings School of Global Public Health
Methods for Classifying Patient Histories in Secondary Healthcare Data
In clinical safety and effectiveness research using secondary health databases, patient medical histories are typically assessed using fixed look-back approaches. Conventional applications of these approaches exclude patients who are not continuously enrolled in the database for the entire look-back period (e.g. one year), and data occurring outside this period is ignored. An alternate approach has been suggested which assesses all of the available data history, though concerns exist that results may be biased by systematic variation in the amount of available database across important study groups.
We used applied analyses as well as plasmode simulation methods to explore the application of short (1-year) and long (3-year) fixed look-backs and all-available data approaches in analyses of Medicare fee-for-service (FFS) claims data. We assessed the bias and efficiency of effect estimates when we used the different look-backs to 1) assess cohort eligibility and to 2) identify and adjust for confounders. In the applied analysis, we evaluated the effect of statin initiation (vs. non-use) on incidence of 1) cancer within six months (a negative control outcome we expected a priori to be null) and 2) all-cause mortality within two years. In the plasmode simulation, exposures (conceptually: statin initiation vs. non-initiation) and outcomes (conceptually: inpatient hospitalization) were simulated as a function of self-reported interview data obtained from the Medicare Current Beneficiary Survey (MCBS, which represented the true underlying confounder of exposure-outcome associations. We evaluated estimates after applying different look-back approaches in the linked claims data.
Compared to short fixed look-back approaches, all-available approaches selected cohorts with superior classification and produced less biased estimates. Compared to long fixed look-back approaches, all-available approaches selected more inclusive cohorts and produced more precise estimates. Though these studies were conducted in a fairly narrow (applied) setting, our findings provide real-world evidence that using all-available look-backs to classify patient histories is superior to fixed look-back approaches. Our findings provide context to investigators seeking to understand the mechanisms through which the different look-backs may produce different estimates.
2017-12
2017
Epidemiology
Public health
administrative claims, databases, epidemiologic methods, longitudinal studies, look-back periods, plasmode simulation
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Michele
Jonsson Funk
Thesis advisor
Til
Stürmer
Thesis advisor
Charles
Poole
Thesis advisor
Robert
Glynn
Thesis advisor
Ross
Simpson
Jr.
Thesis advisor
text
Mitchell
Conover
Creator
Department of Epidemiology
Gillings School of Global Public Health
Methods for Classifying Patient Histories in Secondary Healthcare Data
In clinical safety and effectiveness research using secondary health databases, patient medical histories are typically assessed using fixed look-back approaches. Conventional applications of these approaches exclude patients who are not continuously enrolled in the database for the entire look-back period (e.g. one year), and data occurring outside this period is ignored. An alternate approach has been suggested which assesses all of the available data history, though concerns exist that results may be biased by systematic variation in the amount of available database across important study groups.
We used applied analyses as well as plasmode simulation methods to explore the application of short (1-year) and long (3-year) fixed look-backs and all-available data approaches in analyses of Medicare fee-for-service (FFS) claims data. We assessed the bias and efficiency of effect estimates when we used the different look-backs to 1) assess cohort eligibility and to 2) identify and adjust for confounders. In the applied analysis, we evaluated the effect of statin initiation (vs. non-use) on incidence of 1) cancer within six months (a negative control outcome we expected a priori to be null) and 2) all-cause mortality within two years. In the plasmode simulation, exposures (conceptually: statin initiation vs. non-initiation) and outcomes (conceptually: inpatient hospitalization) were simulated as a function of self-reported interview data obtained from the Medicare Current Beneficiary Survey (MCBS, which represented the true underlying confounder of exposure-outcome associations. We evaluated estimates after applying different look-back approaches in the linked claims data.
Compared to short fixed look-back approaches, all-available approaches selected cohorts with superior classification and produced less biased estimates. Compared to long fixed look-back approaches, all-available approaches selected more inclusive cohorts and produced more precise estimates. Though these studies were conducted in a fairly narrow (applied) setting, our findings provide real-world evidence that using all-available look-backs to classify patient histories is superior to fixed look-back approaches. Our findings provide context to investigators seeking to understand the mechanisms through which the different look-backs may produce different estimates.
2017-12
2017
Epidemiology
Public health
administrative claims, databases, epidemiologic methods, longitudinal studies, look-back periods, plasmode simulation
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Michele
Jonsson Funk
Thesis advisor
Til
Stürmer
Thesis advisor
Charles
Poole
Thesis advisor
Robert
Glynn
Thesis advisor
Ross
Simpson
Jr.
Thesis advisor
text
Mitchell
Conover
Creator
Department of Epidemiology
Gillings School of Global Public Health
Methods for Classifying Patient Histories in Secondary Healthcare Data
In clinical safety and effectiveness research using secondary health databases, patient medical histories are typically assessed using fixed look-back approaches. Conventional applications of these approaches exclude patients who are not continuously enrolled in the database for the entire look-back period (e.g. one year), and data occurring outside this period is ignored. An alternate approach has been suggested which assesses all of the available data history, though concerns exist that results may be biased by systematic variation in the amount of available database across important study groups.
We used applied analyses as well as plasmode simulation methods to explore the application of short (1-year) and long (3-year) fixed look-backs and all-available data approaches in analyses of Medicare fee-for-service (FFS) claims data. We assessed the bias and efficiency of effect estimates when we used the different look-backs to 1) assess cohort eligibility and to 2) identify and adjust for confounders. In the applied analysis, we evaluated the effect of statin initiation (vs. non-use) on incidence of 1) cancer within six months (a negative control outcome we expected a priori to be null) and 2) all-cause mortality within two years. In the plasmode simulation, exposures (conceptually: statin initiation vs. non-initiation) and outcomes (conceptually: inpatient hospitalization) were simulated as a function of self-reported interview data obtained from the Medicare Current Beneficiary Survey (MCBS, which represented the true underlying confounder of exposure-outcome associations. We evaluated estimates after applying different look-back approaches in the linked claims data.
Compared to short fixed look-back approaches, all-available approaches selected cohorts with superior classification and produced less biased estimates. Compared to long fixed look-back approaches, all-available approaches selected more inclusive cohorts and produced more precise estimates. Though these studies were conducted in a fairly narrow (applied) setting, our findings provide real-world evidence that using all-available look-backs to classify patient histories is superior to fixed look-back approaches. Our findings provide context to investigators seeking to understand the mechanisms through which the different look-backs may produce different estimates.
2017-12
2017
Epidemiology
Public health
administrative claims, databases, epidemiologic methods, longitudinal studies, look-back periods, plasmode simulation
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Michele
Jonsson Funk
Thesis advisor
Til
Stürmer
Thesis advisor
Charles
Poole
Thesis advisor
Robert
Glynn
Thesis advisor
Ross
Simpson
Jr.
Thesis advisor
text
Mitchell
Conover
Creator
Department of Epidemiology
Gillings School of Global Public Health
Methods for Classifying Patient Histories in Secondary Healthcare Data
In clinical safety and effectiveness research using secondary health databases, patient medical histories are typically assessed using fixed look-back approaches. Conventional applications of these approaches exclude patients who are not continuously enrolled in the database for the entire look-back period (e.g. one year), and data occurring outside this period is ignored. An alternate approach has been suggested which assesses all of the available data history, though concerns exist that results may be biased by systematic variation in the amount of available database across important study groups.
We used applied analyses as well as plasmode simulation methods to explore the application of short (1-year) and long (3-year) fixed look-backs and all-available data approaches in analyses of Medicare fee-for-service (FFS) claims data. We assessed the bias and efficiency of effect estimates when we used the different look-backs to 1) assess cohort eligibility and to 2) identify and adjust for confounders. In the applied analysis, we evaluated the effect of statin initiation (vs. non-use) on incidence of 1) cancer within six months (a negative control outcome we expected a priori to be null) and 2) all-cause mortality within two years. In the plasmode simulation, exposures (conceptually: statin initiation vs. non-initiation) and outcomes (conceptually: inpatient hospitalization) were simulated as a function of self-reported interview data obtained from the Medicare Current Beneficiary Survey (MCBS, which represented the true underlying confounder of exposure-outcome associations. We evaluated estimates after applying different look-back approaches in the linked claims data.
Compared to short fixed look-back approaches, all-available approaches selected cohorts with superior classification and produced less biased estimates. Compared to long fixed look-back approaches, all-available approaches selected more inclusive cohorts and produced more precise estimates. Though these studies were conducted in a fairly narrow (applied) setting, our findings provide real-world evidence that using all-available look-backs to classify patient histories is superior to fixed look-back approaches. Our findings provide context to investigators seeking to understand the mechanisms through which the different look-backs may produce different estimates.
2017-12
2017
Epidemiology
Public health
administrative claims, databases, epidemiologic methods, longitudinal studies, look-back periods, plasmode simulation
eng
Doctor of Philosophy
Dissertation
Epidemiology
Michele
Jonsson Funk
Thesis advisor
Til
Stürmer
Thesis advisor
Charles
Poole
Thesis advisor
Robert
Glynn
Thesis advisor
Ross
Simpson
Jr.
Thesis advisor
text
University of North Carolina at Chapel Hill
Degree granting institution
Mitchell
Conover
Creator
Department of Epidemiology
Gillings School of Global Public Health
Methods for Classifying Patient Histories in Secondary Healthcare Data
In clinical safety and effectiveness research using secondary health databases, patient medical histories are typically assessed using fixed look-back approaches. Conventional applications of these approaches exclude patients who are not continuously enrolled in the database for the entire look-back period (e.g. one year), and data occurring outside this period is ignored. An alternate approach has been suggested which assesses all of the available data history, though concerns exist that results may be biased by systematic variation in the amount of available database across important study groups.
We used applied analyses as well as plasmode simulation methods to explore the application of short (1-year) and long (3-year) fixed look-backs and all-available data approaches in analyses of Medicare fee-for-service (FFS) claims data. We assessed the bias and efficiency of effect estimates when we used the different look-backs to 1) assess cohort eligibility and to 2) identify and adjust for confounders. In the applied analysis, we evaluated the effect of statin initiation (vs. non-use) on incidence of 1) cancer within six months (a negative control outcome we expected a priori to be null) and 2) all-cause mortality within two years. In the plasmode simulation, exposures (conceptually: statin initiation vs. non-initiation) and outcomes (conceptually: inpatient hospitalization) were simulated as a function of self-reported interview data obtained from the Medicare Current Beneficiary Survey (MCBS, which represented the true underlying confounder of exposure-outcome associations. We evaluated estimates after applying different look-back approaches in the linked claims data.
Compared to short fixed look-back approaches, all-available approaches selected cohorts with superior classification and produced less biased estimates. Compared to long fixed look-back approaches, all-available approaches selected more inclusive cohorts and produced more precise estimates. Though these studies were conducted in a fairly narrow (applied) setting, our findings provide real-world evidence that using all-available look-backs to classify patient histories is superior to fixed look-back approaches. Our findings provide context to investigators seeking to understand the mechanisms through which the different look-backs may produce different estimates.
2017-12
2017
Epidemiology
Public health
administrative claims; databases; epidemiologic methods; longitudinal studies; look-back periods; plasmode simulation
eng
Doctor of Philosophy
Dissertation
Epidemiology
Michele
Jonsson Funk
Thesis advisor
Til
Stürmer
Thesis advisor
Charles
Poole
Thesis advisor
Robert
Glynn
Thesis advisor
Ross
Simpson
Jr.
Thesis advisor
text
University of North Carolina at Chapel Hill
Degree granting institution
Mitchell
Conover
Creator
Department of Epidemiology
Gillings School of Global Public Health
Methods for Classifying Patient Histories in Secondary Healthcare Data
In clinical safety and effectiveness research using secondary health databases, patient medical histories are typically assessed using fixed look-back approaches. Conventional applications of these approaches exclude patients who are not continuously enrolled in the database for the entire look-back period (e.g. one year), and data occurring outside this period is ignored. An alternate approach has been suggested which assesses all of the available data history, though concerns exist that results may be biased by systematic variation in the amount of available database across important study groups.
We used applied analyses as well as plasmode simulation methods to explore the application of short (1-year) and long (3-year) fixed look-backs and all-available data approaches in analyses of Medicare fee-for-service (FFS) claims data. We assessed the bias and efficiency of effect estimates when we used the different look-backs to 1) assess cohort eligibility and to 2) identify and adjust for confounders. In the applied analysis, we evaluated the effect of statin initiation (vs. non-use) on incidence of 1) cancer within six months (a negative control outcome we expected a priori to be null) and 2) all-cause mortality within two years. In the plasmode simulation, exposures (conceptually: statin initiation vs. non-initiation) and outcomes (conceptually: inpatient hospitalization) were simulated as a function of self-reported interview data obtained from the Medicare Current Beneficiary Survey (MCBS, which represented the true underlying confounder of exposure-outcome associations. We evaluated estimates after applying different look-back approaches in the linked claims data.
Compared to short fixed look-back approaches, all-available approaches selected cohorts with superior classification and produced less biased estimates. Compared to long fixed look-back approaches, all-available approaches selected more inclusive cohorts and produced more precise estimates. Though these studies were conducted in a fairly narrow (applied) setting, our findings provide real-world evidence that using all-available look-backs to classify patient histories is superior to fixed look-back approaches. Our findings provide context to investigators seeking to understand the mechanisms through which the different look-backs may produce different estimates.
2017-12
2017
Epidemiology
Public health
administrative claims, databases, epidemiologic methods, longitudinal studies, look-back periods, plasmode simulation
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Epidemiology
Michele
Jonsson Funk
Thesis advisor
Til
Stürmer
Thesis advisor
Charles
Poole
Thesis advisor
Robert
Glynn
Thesis advisor
Ross
Simpson
Jr.
Thesis advisor
text
Mitchell
Conover
Creator
Department of Epidemiology
Gillings School of Global Public Health
Methods for Classifying Patient Histories in Secondary Healthcare Data
In clinical safety and effectiveness research using secondary health databases, patient medical histories are typically assessed using fixed look-back approaches. Conventional applications of these approaches exclude patients who are not continuously enrolled in the database for the entire look-back period (e.g. one year), and data occurring outside this period is ignored. An alternate approach has been suggested which assesses all of the available data history, though concerns exist that results may be biased by systematic variation in the amount of available database across important study groups.
We used applied analyses as well as plasmode simulation methods to explore the application of short (1-year) and long (3-year) fixed look-backs and all-available data approaches in analyses of Medicare fee-for-service (FFS) claims data. We assessed the bias and efficiency of effect estimates when we used the different look-backs to 1) assess cohort eligibility and to 2) identify and adjust for confounders. In the applied analysis, we evaluated the effect of statin initiation (vs. non-use) on incidence of 1) cancer within six months (a negative control outcome we expected a priori to be null) and 2) all-cause mortality within two years. In the plasmode simulation, exposures (conceptually: statin initiation vs. non-initiation) and outcomes (conceptually: inpatient hospitalization) were simulated as a function of self-reported interview data obtained from the Medicare Current Beneficiary Survey (MCBS, which represented the true underlying confounder of exposure-outcome associations. We evaluated estimates after applying different look-back approaches in the linked claims data.
Compared to short fixed look-back approaches, all-available approaches selected cohorts with superior classification and produced less biased estimates. Compared to long fixed look-back approaches, all-available approaches selected more inclusive cohorts and produced more precise estimates. Though these studies were conducted in a fairly narrow (applied) setting, our findings provide real-world evidence that using all-available look-backs to classify patient histories is superior to fixed look-back approaches. Our findings provide context to investigators seeking to understand the mechanisms through which the different look-backs may produce different estimates.
2017-12
2017
Epidemiology
Public health
administrative claims; databases; epidemiologic methods; longitudinal studies; look-back periods; plasmode simulation
eng
Doctor of Philosophy
Dissertation
University of North Carolina at Chapel Hill Graduate School
Degree granting institution
Michele
Jonsson Funk
Thesis advisor
Til
Stürmer
Thesis advisor
Charles
Poole
Thesis advisor
Robert
Glynn
Thesis advisor
Ross
Simpson
Jr.
Thesis advisor
text
2019-12-31T00:00:00
2017-11-30T15:35:08Z
proquest
Methods for Classifying Patient Histories in Secondary Healthcare Data
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