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Assessing the impacts of governance reforms on health services delivery: a quasi-experimental, multi-method, and participatory approach
AbstractDespite considerable advances in developing new and more sophisticated impact evaluation methodologies and toolkits, policy research continues to suffer from persistent challenges in achieving the evaluation trifecta: identifying effects, isolating mechanisms, and influencing policy. For example, evaluation studies are routinely hampered by problems of establishing valid counterfactuals due to endogeneity and selection effects with respect to policy reform. Additionally, robust evaluation studies often must contend with heterogeneity in treatment, staggered timing, and variation in uptake. And finally, on practical...
Source: Health Services and Outcomes Research Methodology - June 26, 2019 Category: Statistics Source Type: research

Developing and evaluating methods to impute race/ethnicity in an incomplete dataset
The objective of this study was to address these limitations by developing novel methods for imputing race/ethnicity when this information is partially missing. By viewing the unobserved race as missing data, we explored different multiple imputation methods for imputing race/ethnicity, and we applied these methods to a subset of Rhode Island Medicaid beneficiaries. Current race imputation methods and newly developed ones were compared using area under the ROC curve statistics and racial composition estimates to identify methods and sets of predictors that yield superior race imputations. Family race was identified as an i...
Source: Health Services and Outcomes Research Methodology - June 7, 2019 Category: Statistics Source Type: research

Modeling determinants of time-to-circumcision of girls: a comparison of various parametric shared frailty models
This study aimed to model and investigate the potential risk factors of time-to-circumcision of girls in Ethiopia using parametric shared frailty models where regional states of the girls were used as a clustering effect in the models. The data source for the analysis was the 2016 EDHS data collected from January 18, 2016 up to June 27, 2016 from which the survival information of 2930 girls on age at circumcision obtained. The gamma and inverse Gaussian shared frailty distributions with Exponential, Weibull and log-logistic baseline models was employed to analyze risk factors associated with age at circumcision using socio...
Source: Health Services and Outcomes Research Methodology - June 6, 2019 Category: Statistics Source Type: research

Causal difference-in-differences estimation for evaluating the impact of semi-continuous medical home scores on health care for children
AbstractDifference-in-differences (DID) is a popular approach in observational and quasi-experimental studies to estimate the effects of a treatment with discrete statuses. In many studies, however, the treatment can have a range of dosages or exposure levels. In our paper, “medical homeness” is a semi-continuous score ranging from 0 to 100 to indicate the extent to which a patient-centered medical home model is achieved. We developed a causal DID approach to estimating the effects of a treatment with semi-continuous dosages. The proposed approach allows for mixed- type designs as well as different propensity models. W...
Source: Health Services and Outcomes Research Methodology - February 9, 2019 Category: Statistics Source Type: research

Guest editorial summary on articles selected from the 2018 International Conference on Health Policy Statistics
(Source: Health Services and Outcomes Research Methodology)
Source: Health Services and Outcomes Research Methodology - January 24, 2019 Category: Statistics Source Type: research

Model-based inference on average causal effect in observational clustered data
We present a summary of our comprehensive simulation study assessing the repetitive sampling properties of the two approaches in a pseudo-random simulation environment. Finally, we report our findings from an application to study the ACE of inadequate prenatal care on birth weight among low-income women in New York State. (Source: Health Services and Outcomes Research Methodology)
Source: Health Services and Outcomes Research Methodology - January 16, 2019 Category: Statistics Source Type: research

Asthma at mid-life is associated with physical activity limits but not obesity after 10  years using matched sampling in a nationally representative sample
This study examines whether asthma is associated with obesity and physical activity limits 10  years later among a subsample from the National Longitudinal Survey of Youth 1979 who were age 40 at baseline. We addressed selection bias using inverse-propensity score weighting (N = 5077), and confirmed the results with full matching (N = 5041), and with both methods we estimated new sa mpling weights so that the sample would remain nationally representative. Both matched sampling methods balanced adults with asthma versus those without asthma on all 7 covariates: baseline obesity, sex, race/ethnicity, family income, ...
Source: Health Services and Outcomes Research Methodology - January 11, 2019 Category: Statistics Source Type: research

Pragmatic randomized clinical trials: best practices and statistical guidance
AbstractRandomized clinical trials often serve the purpose of assessing the efficacy and safety of a compound. By combining real-world evidence and randomization, pragmatic randomized clinical trials (PrCTs) can be used to inform treatment effectiveness and healthcare decisions. PrCTs, referring to studies where several pragmatic elements are used (eligibility, endpoints, follow-up, etc.), pose unique challenges (Loudon et al. in BMJ 350:h2147,2015). From a literature review, we propose a definition of PrCT and discuss strategies to overcome some PrCT challenges. Use of alternative data collection approaches may lead to un...
Source: Health Services and Outcomes Research Methodology - December 1, 2018 Category: Statistics Source Type: research

A conversation with Sally C. Morton: excellence in health policy statistics
This article is conversation with Morton about her career. (Source: Health Services and Outcomes Research Methodology)
Source: Health Services and Outcomes Research Methodology - November 27, 2018 Category: Statistics Source Type: research

Addressing missing data in confounders when estimating propensity scores for continuous exposures
AbstractPropensity score models are frequently used to estimate causal effects in observational studies. One unresolved issue in fitting these models is handling missing values in the propensity score model covariates. As these models usually contain a large set of covariates, using only individuals with complete data significantly decreases the sample size and statistical power. Several missing data imputation approaches have been proposed, including multiple imputation (MI), MI with missingness pattern (MIMP), and treatment mean imputation. Generalized boosted modeling (GBM), which is a nonparametric approach to estimate...
Source: Health Services and Outcomes Research Methodology - October 26, 2018 Category: Statistics Source Type: research

Bayesian bivariate subgroup analysis for risk –benefit evaluation
AbstractSubgroup analysis is a frequently used tool for evaluating heterogeneity of treatment effect and heterogeneity in treatment harm across observed baseline patient characteristics. While treatment efficacy and adverse event measures are often reported separately for each subgroup, analyzing their within-subgroup joint distribution is critical for better informed patient decision-making. In this paper, we describe Bayesian models for performing a subgroup analysis to compare the joint occurrence of a primary endpoint and an adverse event between two treatment arms. Our approach emphasizes estimation of heterogeneity i...
Source: Health Services and Outcomes Research Methodology - October 16, 2018 Category: Statistics Source Type: research

A conversation including 39 questions with Anirban Basu
AbstractAt the 2018 International Conference on Health Policy Statistics (ICHPS) held in Charleston, South Carolina, Anirban Basu was awarded the Mid-Career Excellence Award from the American Statistical Association Section on Health Policy Statistics (HPSS). Anirban was exceptionally and uniquely qualified for this award. Highlights include his providing outstanding service to the HPSS, advancing statistical methodology, advancing methodology in other domains of health policy, and performing extensive and highly impactful applied work in medicine and health care. In this interview, we trace Anirban ’s upbringing, school...
Source: Health Services and Outcomes Research Methodology - October 4, 2018 Category: Statistics Source Type: research

Difference-in-differences and matching on outcomes: a tale of two unobservables
AbstractDifference-in-differences combined with matching on pre-treatment outcomes is a popular method for addressing non-parallel trends between a treatment and control group. However, previous simulations suggest that this approach does not always eliminate or reduce bias, and it is not clear when and why. Using Medicaid claims data from Oregon, we systematically vary the distribution of two key unobservables —fixed effects and the random error term—to examine how they affect bias of matching on pre-treatment outcomes levels or trends combined with difference-in-differences. We find that in most scenarios, bias incre...
Source: Health Services and Outcomes Research Methodology - October 3, 2018 Category: Statistics Source Type: research