Propensity scores

25 Jul

Propensity score gives the probability of a subject in a population to belong to a group of interest such as a treatment group.
Then comparing subjects with the same propensity scores across treatment and no-treatment groups enables the researcher to infer on the effect of the treatment regarding a given outcome even if he works on merely observational data.
But the researcher must beware of the unobserved differences between the group of interest and the comparison group created using the propensity score.
As always the relevance of the model depends on the nature of the covariates entered in it.

Garrido, M. M., Kelley, A. S., Paris, J., Roza, K., Meier, D. E., Morrison, R. S. and Aldridge, M. D. (2014), Methods for Constructing and Assessing Propensity Scores. Health Services Research. doi: 10.1111/1475-6773.12182

http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12182/abstract

http://theincidentaleconomist.com/wordpress/methods-propensity-scores/

Case base study vs case control study

25 Jul

Unlike the case control studies the case base studies are well suited to the cross sectional extractions from the reimbursement data bases that we usually do.
The case base studies use the whole population of the database as a control group , including the subjects who are affected by the disease (ie the cases).
Thus, making no difference whether the subjects have the disease or not , the control group is far more easy to constitute.

Citation: Chui TT-T, Lee W-C (2013) A Regression-Based Method for Estimating Risks and Relative Risks in Case-Base Studies. PLoS ONE 8(12): e83275. doi:10.1371/journal.pone.0083275

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0083275#pone-0083275-g001

New blood thinners: the French studies in real life.

14 Jul

One more time CNAMTS boys have crunched the numbers from the reimbursement data bases.
They previously had done this exercise in real life for the mediator and they had found cardiac side effects. This time they investigated a new category of blood thinner the NACOs (Nouveaux Anti Coagulants). Unlike the mediator they have concluded that in the short term (3 months) no evidence of any adverse side effects such as bleeding or thrombosis could be found.

The mediator study:

http://www.ncbi.nlm.nih.gov/pubmed/20945504#

The NACOS study of the risk associated with the initiation of treatment with the new blood thinner in anticoagulant treatment naive patients (3 months of follow up):

http://ansm.sante.fr/var/ansm_site/storage/original/application/6372793e0dfaf927308665a647ed0444.pdf

The NACOS study of the risk associated with the change in treatment consisting in replacing Warfarin by the new blood thinner in anticoagulant treatment experienced patients (4 months of follow up):

http://ansm.sante.fr/var/ansm_site/storage/original/application/5504a80da7d6ec6eab26798eebf64fb3.pdf

Massaging Medicaid

3 Jun

A week-and-a-half ago, the D.C. Circuit upheld the criminal conviction of the owner of a clinic that bilked Medicaid out of millions of dollars: Wheeler owned

via Massaging Medicaid.

France has the best health care system in the world

30 May

It’s not me it’s Aaron Carroll from healthcare Triage who says that:

 

 

 

 

listening

30 May

Originally posted on earthskybelly:

 

let me catch my breath, she says

I can’t breathe

her brow is folded into deep furrows

like ancient river beds curved over time

 revealing the frustration with an old body

once so familiar and resilient

that now simply fails to take care of the basics

like breathing

and balance…knowing where the earth lies

underfoot

I also see the fear

as her hands reach up to her head

grasping for comfort or fending off the overwhelming onslaught

of questions and concerns and suggestions and pleas for her to just try

just try to accept this wearing down of time

as if I can know how she really feels

or what it’s like to become acquainted with so few remaining months, weeks, maybe days

I can only offer my presence and attention

not to say, oh I know…because I don’t

but to simply be there, listening

letting her say all…

View original 18 more words

Miss Maya

30 May

Originally posted on earthskybelly:

it was a shock
to read the news

and I felt a momentary sense of loss
when I understood
that she had passed
moved on
left this place
we call Earth
and Home

now I feast upon those words
she spoke
wrote down
proclaimed to the world
of her life
all of it
laid out so carefully and honestly
in full disclosure

what a true warrior she was
never holding back
standing so beautiful and proud
in her nakedness
exposed and raw
unflinching
as she bravely moved on
in spite of
or because of
the strength and wisdom
found in everything
born of everything
that stepped upon her path

what if any one of us
we
could know a fraction
of that unfailing courage
have such faith in ourselves
the will to move on
and the peace that is found there

I am far from that place of bravery
where…

View original 107 more words

It’s not that simple

16 May

It’s not that simple.

The US health coverage system would be the most complex on planet earth according to the article referenced below [1].

Indeed the author of the article published in the rubric “perspective” of the new England Journal of Medicine wrote (quote):

“…the ACA was crafted to leave in place as much as possible of the preexisting system of health insurance. The problem was — and is — that this decision meant that reform had to be built on the most complex, kludgy, and costly system on planet Earth. Multiple layers of health coverage — as a fringe benefit of private employment, as compensation for military service, as public charity for the poor, as public coverage for the elderly and disabled, and as a private commodity purchased by individuals in a remarkably dysfunctional market — overlap and intersect to pay for care through a bewildering variety of agents in a system that even experts seldom fully comprehend.” (end of quote).

Until now I thought it was the French system that occupied the top place with numerous special schemes. If you want to have an idea of the French system you can consult the document issued by the French Agency for the Development and Coordination of International Relations (ADECRI) [2].
click to read the document

Anyway, be it in the US or in France, a nation wide health care coverage system unavoidably has to be complex if it intends to be comprehensive.

References:
1- Aaron HJ. Here to Stay — Beyond the Rough Launch of the ACA. N Engl J Med. 2014 May;Available from: http://dx.doi.org/10.1056/nejmp1404194 .

2- ADECRI The French Social Protection System, booklet downloadable from the Agency’s website: http://www.adecri.org. Copyright © ADECRI, 2008.

Wage and labor market effects of dependent coverage expansion

14 May

The following originally appeared at The Upshot copyright 2014, The New York Times Company. One of the earliest pieces of the health-care law to go into e

via Wage and labor market effects of dependent coverage expansion.

INDICATORS FOR MONITORING THE HEALTH OF THE POPULATION – FINAL REPORT

11 May

The French government has issued a report enlisting the available surrogates of risk factors, health determinants and health status of the population at a nation’s wide level.
Some experts from the self employed workers social scheme (RSI) participated to the panel of experts.
In many cases, to construct the surrogates the authors of the report plans to use the reimbursement databases of the national mandatory health care insurance schemes. It is the case for example when the surrogate is a recourse rate to a category of treatment or medicine (anti hypertensive treatment; opioid addiction treatment …).
Feel free to consult the report (in French) here:

http://www.drees.sante.gouv.fr/indicateurs-de-suivi-de-l-etat-de-sante-de-la-population,11299.html

and here:
INDICATEURS DE SUIVI DE L’ÉTAT DE SANTE DE LA POPULATION RÉVISION 2013 – RAPPORT FINAL

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