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2017 ; 17
(1
): 42
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The feasibility of matching on a propensity score for acupuncture in a
prospective cohort study of patients with chronic pain
#MMPMID28302054
Johnson ES
; Dickerson JF
; Vollmer WM
; Rowley AM
; Ritenbaugh C
; Deyo RA
; DeBar L
BMC Med Res Methodol
2017[Mar]; 17
(1
): 42
PMID28302054
show ga
BACKGROUND: Propensity scores are typically applied in retrospective cohort
studies. We describe the feasibility of matching on a propensity score derived
from a retrospective cohort and subsequently applied in a prospective cohort
study of patients with chronic musculoskeletal pain before the start of
acupuncture or usual care treatment and enrollment in a comparative effectiveness
study that required patient reported pain outcomes. METHODS: We assembled a
retrospective cohort study using data from 2010 to develop a propensity score for
acupuncture versus usual care based on electronic healthcare record and
administrative data (e.g., pharmacy) from an integrated health plan, Kaiser
Permanente Northwest. The propensity score's probabilities allowed us to match
acupuncture-referred and non-referred patients prospectively in 2013-14 after a
routine outpatient visit for pain. Among the matched patients, we collected
patient-reported pain before treatment and during follow-up to assess the
comparative effectiveness of acupuncture. We assessed balance in patient
characteristics with the post-matching c-statistic and standardized differences.
RESULTS: Based on the propensity score and other characteristics (e.g.,
patient-reported pain), we were able to match all 173 acupuncture-referred
patients to 350 non-referred (usual care) patients. We observed a residual
imbalance (based on the standardized differences) for some characteristics that
contributed to the score; for example, age, -0.283, and the Charlson comorbidity
score, -0.264, had the largest standardized differences. The overall balance of
the propensity score appeared more favorable according to the post-matching
c-statistic, 0.503. CONCLUSION: The propensity score matching was feasible
statistically and logistically and allowed approximate balance on patient
characteristics, some of which will require adjustment in the comparative
effectiveness regression model. By transporting propensity scores to new
patients, healthcare systems with electronic health records can conduct
comparative effectiveness cohort studies that require prospective data
collection, such as patient-reported outcomes, while approximately balancing
numerous patient characteristics that might confound the benefit of an
intervention. The approach offers a new study design option.
|*Propensity Score
[MESH]
|Acupuncture Therapy/*statistics & numerical data
[MESH]