Bayesian Nonparametric Policy Search With Application to Periodontal Recall Intervals

2020
Tooth loss from periodontal disease is a major public health burden in the United States. Standard clinical practice is to recommend a dental visit every six months; however, this practice is not evidence-based, and poor dental outcomes and increasing dental insurance premiums indicate room for improvement. We consider a tailored approach that recommends recall time based on patient characteristics and medical history to minimize disease progression without increasing resource expenditures. We formalize this method as a dynamic treatment regime which comprises a sequence of decisions, one per stage of intervention, that follow a decision rule which maps current patient information to a recommendation for their next visit time. The dynamics of periodontal health, visit frequency, and patient compliance are complex, yet the estimated optimal regime must be interpretable to domain experts if it is to be integrated into clinical practice. We combine nonparametric Bayesian dynamics modeling with policy-search algorithms to estimate the optimal dynamic treatment regime within an interpretable class of regimes. Both simulation experiments and application to a rich database of electronic dental records from the HealthPartners HMO shows that our proposed method leads to better dental health without increasing the average recommended recall time relative to competing methods. for this article, including a standardized description of the materials available for reproducing the work, are available as an online supplement.
JOURNAL OF THE AMERICAN STATISTICAL ASSOCIATION
页码:1066-1078|卷号:115|期号:531
ISSN:0162-1459
收录类型
SSCI
发表日期
2020
学科领域
循证社会科学-方法
国家
美国
语种
英语
DOI
10.1080/01621459.2019.1660169
其他关键词
DYNAMIC TREATMENT REGIMES; LEARNING-METHODS; RISK; PREVALENCE; DISEASE; MODELS
EISSN
1537-274X
资助机构
NCI NIH HHSUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Cancer Institute (NCI) [P01 CA142538] Funding Source: Medline; NIDCR NIH HHSUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of Dental & Craniofacial Research (NIDCR) [R01 DE024984] Funding Source: Medline
被引频次(WOS)
2
被引更新日期
2022-01
来源机构
University of North Carolina North Carolina State University Virginia Commonwealth University
关键词
Dirichlet process prior Dynamic treatment regimes Observational data Periodontal disease Practice-based setting Precision medicine Sequential optimization