Public Health Commons^™

Active Presecription Drug Safety Surveillance: Exploring Omop 2011-2012 Experiments, Susan Gruber, James M. Robins

Susan Gruber

The Observational Medical Outcomes Partnership (OMOP), a consortium of pharmaceutical, FDA, and academic researchers focuses on developing and evaluating electronic records-based methods for enhancing post-market drug safety surveillance. The OMOP 2011-2012 experiment consists of applying variants of seven analysis methods to five different EMR or claims databases to estimate the increase (decrease) in risk associated with drug-outcome pairs whose causal association has been previously established, and serves as a gold standard for comparison. Variants of each method can produce very different effect estimates, sometimes at odds with the gold standard. We explore the reasons behind this heterogeneity, and in doing …

Designing The Search Trial: Ph250b In Practice, Laura Balzer

Laura B. Balzer

No abstract provided.

Managed Care, Hospice Use, Site Of Death, And Medical Expenditures In The Last Year Of Life, Ezekiel Emanuel, Arlene Ash, Wei Yu, Gail Gazelle, Norman Levinsky, Olga Saynina, Mark Mcclellan, Mark Moskowitz

wei yu

BACKGROUND: We examined deaths of Medicare beneficiaries in Massachusetts and California to evaluate the effect of managed care on the use of hospice and site of death and to determine how hospice affects the expenditures for the last year of life.

METHODS: Medicare data for beneficiaries in Massachusetts (n = 37 933) and California (n = 27 685) who died in 1996 were merged with each state's death certificate files to determine site and cause of death. Expenditure data were Health Care Financing Administration payments and were divided into 30-day periods from the date of death back 12 months.

RESULTS: …

Estimating The Effect Of A Community-Based Intervention With Two Communities, Mark Van Der Laan, Maya Petersen, Wenjing Zheng

Wenjing Zheng

Due to the need to evaluate the effectiveness of community-based programs in practice, there is substantial interest in methods to estimate the causal effects of community-level treatments or exposures on individual level outcomes. The challenge one is confronted with is that different communities have different environmental factors affecting the individual outcomes, and all individuals in a community share the same environment and intervention. In practice, data are often available from only a small number of communities, making it difficult if not impossible to adjust for these environmental confounders. In this paper we consider an extreme version of this dilemma, in …

Microbes In Pool Filter Backwash As Evidence Of The Need For Improved Swimmer Hygiene — Metro-Atlanta, Georgia, 2012, Christopher Hutcheson, Ryan Cira, Stanley L. Gaines, Kevin R. Jones, Walter Howard, David Hornsby, Maurice Redmond, R. Christopher Rustin, Michele C. Hlavsa, Jennifer L. Murphy, Jothikumar Narayanan, Candace D. Miller, Brittany Cantrell, Vincent R. Hill, Michael J. Beach

R. Christopher Rustin

Estimating Effects On Rare Outcomes: Knowledge Is Power, Laura B. Balzer, Mark J. Van Der Laan

Laura B. Balzer

Many of the secondary outcomes in observational studies and randomized trials are rare. Methods for estimating causal effects and associations with rare outcomes, however, are limited, and this represents a missed opportunity for investigation. In this article, we construct a new targeted minimum loss-based estimator (TMLE) for the effect of an exposure or treatment on a rare outcome. We focus on the causal risk difference and statistical models incorporating bounds on the conditional risk of the outcome, given the exposure and covariates. By construction, the proposed estimator constrains the predicted outcomes to respect this model knowledge. Theoretically, this bounding provides …

A Case-Control Study Of Physical Activity Patterns And Risk Of Non-Fatal Myocardial Infarction, Jian Gong, Hannia Campos, Mark Fiecas, Stephen Mcgarvey, Robert Goldberg, Caroline Richardson, Ana Baylin

Mark Fiecas

Background The interactive effects of different types of physical activity on cardiovascular disease (CVD) risk have not been fully considered in previous studies. We aimed to identify physical activity patterns that take into account combinations of physical activities and examine the association between derived physical activity patterns and risk of acute myocardial infarction (AMI). Methods We examined the relationship between physical activity patterns, identified by principal component analysis (PCA), and AMI risk in a case-control study of myocardial infarction in Costa Rica (N=4172), 1994-2004. The component scores derived from PCA and total METS were used in natural cubic spline models …

Progression From New Methicillin-Resistant Staphylococcus Aureus Colonisation To Infection: An Observational Study In A Hospital Cohort, Michelle Nd Balm, Andrew A. Lover, Sharon Salmon, Paul A. Tambyah, Dale A. Fisher

Andrew Lover

Quantifying Effect Of Geographic Location On Epidemiology Of Plasmodium Vivax Malaria, Andrew A. Lover, Richard J. Coker

Andrew Lover

Methods For Evaluating Prediction Performance Of Biomarkers And Tests, Margaret S. Pepe Phd, Holly Janes Phd

Margaret S Pepe PhD

This chapter describes and critiques methods for evaluating the performance of markers to predict risk of a current or future clinical outcome. We consider three criteria that are important for evaluating a risk model: calibration, benefit for decision making and accurate classification. We also describe and discuss a variety of summary measures in common use for quantifying predictive information such as the area under the ROC curve and R-squared. The roles and problems with recently proposed risk reclassification approaches are discussed in detail.