The Annals of Applied Statistics

Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects

Jared D. Huling, Menggang Yu, and Maureen Smith

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Abstract

With the growing cost of health care in the United States, the need to improve efficiency and efficacy has become increasingly urgent. There has been a keen interest in developing interventions to effectively coordinate the typically fragmented care of patients with many comorbidities. Evaluation of such interventions is often challenging given their long-term nature and their differential effectiveness among different patients. Furthermore, care coordination interventions are often highly resource-intensive. Hence there is pressing need to identify which patients would benefit the most from a care coordination program. In this work we introduce a subgroup identification procedure for long-term interventions whose effects are expected to change smoothly over time. We allow differential effects of an intervention to vary over time and encourage these effects to be more similar for closer time points by utilizing a fused lasso penalty. Our approach allows for flexible modeling of temporally changing intervention effects while also borrowing strength in estimation over time. We utilize our approach to construct a personalized enrollment decision rule for a complex case management intervention in a large health system and demonstrate that the enrollment decision rule results in improvement in health outcomes and care costs. The proposed methodology could have broad usage for the analysis of different types of long-term interventions or treatments including other interventions commonly implemented in health systems.

Article information

Source
Ann. Appl. Stat., Volume 13, Number 2 (2019), 824-847.

Dates
Received: December 2017
Revised: September 2018
First available in Project Euclid: 17 June 2019

Permanent link to this document
https://projecteuclid.org/euclid.aoas/1560758429

Digital Object Identifier
doi:10.1214/18-AOAS1216

Mathematical Reviews number (MathSciNet)
MR3963554

Keywords
Fused lasso precision medicine comparative effectiveness research electronic health records interaction modeling

Citation

Huling, Jared D.; Yu, Menggang; Smith, Maureen. Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects. Ann. Appl. Stat. 13 (2019), no. 2, 824--847. doi:10.1214/18-AOAS1216. https://projecteuclid.org/euclid.aoas/1560758429


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Supplemental materials

  • Supplement A: “Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects”. We provide derivation of the validity of the matching version of our estimator and additional simulation results under nonlinear main effects.
  • Supplement B: personalizedLong_0.0.1. We provide an R implementation of the proposed methodology.