Abstract
BackgroundSeveral methodological issues with non-randomized comparative clinical studies have been raised, one of which is whether the methods used can adequately identify uncertainties that evolve dynamically with time in real-world systems. The objective of this study is to compare the effectiveness of different combinations of Traditional Chinese Medicine (TCM) treatments and combinations of TCM and Western medicine interventions in patients with acute ischemic stroke (AIS) by using Markov decision process (MDP) theory. MDP theory appears to be a promising new method for use in comparative effectiveness research.MethodsThe electronic health records (EHR) of patients with AIS hospitalized at the 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine between May 2005 and July 2008 were collected. Each record was portioned into two "state-action-reward" stages divided by three time points: the first, third, and last day of hospital stay. We used the well-developed optimality technique in MDP theory with the finite horizon criterion to make the dynamic comparison of different treatment combinations.ResultsA total of 1504 records with a primary diagnosis of AIS were identified. Only states with more than 10 (including 10) patients' information were included, which gave 960 records to be enrolled in the MDP model. Optimal combinations were obtained for 30 types of patient condition.ConclusionMDP theory makes it possible to dynamically compare the effectiveness of different combinations of treatments. However, the optimal interventions obtained by the MDP theory here require further validation in clinical practice. Further exploratory studies with MDP theory in other areas in which complex interventions are common would be worthwhile.
Highlights
Several methodological issues with non-randomized comparative clinical studies have been raised, one of which is whether the methods used can adequately identify uncertainties that evolve dynamically with time in real-world systems
Description of patients’ condition and the criterion to be optimized To determine the key characteristics for describing the condition of patients with acute ischemic stroke (AIS) and the criterion to be optimized by using Markov decision process (MDP) theory, an expert panel was formed that included scholars, physicians of Western medicine, Traditional Chinese Medicine (TCM) practitioners, and doctors in the field of integrative medicine, and a half-day expert panel meeting was held
The results of this study indicate that the new method of MDPs may prove useful for comparative effectiveness research (CER)
Summary
Several methodological issues with non-randomized comparative clinical studies have been raised, one of which is whether the methods used can adequately identify uncertainties that evolve dynamically with time in real-world systems. Non-randomized comparative clinical studies play an important role in assessing the safety and effectiveness of medical researchers have made great progress in the development and application of statistical methods for the description and analysis of CER data [5,6,7] Such methods include using propensity score analysis to adjust for group differences [8,9], structural equation models and decomposition methods to identify how outcomes vary differentially with respect to patient characteristics and other factors for alternative treatment cohorts [10], and instrumental variable methods to address the problem of uncontrolled confounding [7,11,12,13,14]. Methods that allow the researcher to model the uncertainties in real-world practice, and especially those that may dynamically change with time, are needed to describe TCM treatments and compare their effectiveness
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