Dataset Information

Can propensity score matching be applied to cross-sectional data to evaluate Community-Based Rehabilitation? Results of a survey implementing the WHO's Community-Based Rehabilitation indicators in Vietnam.

ABSTRACT:

Objectives

Community-Based Rehabilitation (CBR) is a multi-sectoral approach working to equalise opportunities and include people with disabilities in all aspects of life. The complexity of CBR and often limited resources lead to challenges when attempting to quantify its effectiveness, with randomisation and longitudinal data rarely possible. Statistical methods, such as propensity score matching (PSM), offer an alternative approach to evaluate a treatment when randomisation is not feasible. The aim of this study is to examine whether PSM can be an effective method to facilitate evaluations of results in CBR when data are cross-sectional.

Design

Cross-sectional survey.

Setting and participants

Data were collected using the WHO's CBR Indicators in Vietnam, with treatment assignment (participating in CBR or not) determined by province of residence. 298 participants were selected through government records.

Results

PSM was conducted using one-to-one nearest neighbour method on 10 covariates. In the unmatched sample, significant differences between groups were found for six of the 10 covariates. PSM successfully adjusted for bias in all covariates in the matched sample (74 matched pairs). A paired t-test compared the outcome of 'community inclusion' (a score based on selected indicators) between CBR and non-CBR participants for both the matched and unmatched samples, with CBR participants found to have significantly worse community inclusion scores (mean=17.86, SD=6.30, 95%?CI 16.45 to 19.32) than non-CBR participants (mean=20.93, SD=6.16, 95%?CI 19.50 to 22.35); t(73)=3.068, p=0.001. This result did not differ between the matched and unmatched samples.

Conclusion

PSM successfully reduced bias between groups, though its application did not affect the tested outcome. PSM should be considered when analysing cross-sectional CBR data, especially for international comparisons where differences between populations may be greater.

SUBMITTER: Mason C

PROVIDER: S-EPMC6361336 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Can propensity score matching be applied to cross-sectional data to evaluate Community-Based Rehabilitation? Results of a survey implementing the WHO's Community-Based Rehabilitation indicators in Vietnam.

Mason Catherine C Sabariego Carla C Thắng Đoàn Mạnh ĐM Weber Jörg J

BMJ open 20190201 1

<h4>Objectives</h4>Community-Based Rehabilitation (CBR) is a multi-sectoral approach working to equalise opportunities and include people with disabilities in all aspects of life. The complexity of CBR and often limited resources lead to challenges when attempting to quantify its effectiveness, with randomisation and longitudinal data rarely possible. Statistical methods, such as propensity score matching (PSM), offer an alternative approach to evaluate a treatment when randomisation is not feas ...[more]

PMID: 30782679

Similar Datasets

Project description:BackgroundCardinality matching (CM), a novel matching technique, finds the largest matched sample meeting prespecified balance criteria thereby overcoming limitations of propensity score matching (PSM) associated with limited covariate overlap, which are especially pronounced in studies with small sample sizes. The current study proposes a framework for large-scale CM (LS-CM); and compares large-scale PSM (LS-PSM) and LS-CM in terms of post-match sample size, covariate balance and residual confounding at progressively smaller sample sizes.MethodsEvaluation of LS-PSM and LS-CM within a comparative cohort study of new users of angiotensin-converting enzyme inhibitor (ACEI) and thiazide or thiazide-like diuretic monotherapy identified from a U.S. insurance claims database. Candidate covariates included patient demographics, and all observed prior conditions, drug exposures and procedures. Propensity scores were calculated using LASSO regression, and candidate covariates with non-zero beta coefficients in the propensity model were defined as matching covariates for use in LS-CM. One-to-one matching was performed using progressively tighter parameter settings. Covariate balance was assessed using standardized mean differences. Hazard ratios for negative control outcomes perceived as unassociated with treatment (i.e., true hazard ratio of 1) were estimated using unconditional Cox models. Residual confounding was assessed using the expected systematic error of the empirical null distribution of negative control effect estimates compared to the ground truth. To simulate diverse research conditions, analyses were repeated within 10 %, 1 and 0.5 % subsample groups with increasingly limited covariate overlap.ResultsA total of 172,117 patients (ACEI: 129,078; thiazide: 43,039) met the study criteria. As compared to LS-PSM, LS-CM was associated with increased sample retention. Although LS-PSM achieved balance across all matching covariates within the full study population, substantial matching covariate imbalance was observed within the 1 and 0.5 % subsample groups. Meanwhile, LS-CM achieved matching covariate balance across all analyses. LS-PSM was associated with better candidate covariate balance within the full study population. Otherwise, both matching techniques achieved comparable candidate covariate balance and expected systematic error.ConclusionsLS-CM found the largest matched sample meeting prespecified balance criteria while achieving comparable candidate covariate balance and residual confounding. We recommend LS-CM as an alternative to LS-PSM in studies with small sample sizes or limited covariate overlap.

Project description:BackgroundGoal setting is considered 'best practice' in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice. G-AP has 4 stages: goal negotiation, goal setting, action planning & coping planning and appraisal & feedback. All stages are recorded in a patient-held record. In this study we examined the implementation, acceptability and perceived benefits of G-AP in one community rehabilitation team with people recovering from stroke.MethodsG-AP was implemented for 6 months with 23 stroke patients. In-depth interviews with 8 patients and 8 health professionals were analysed thematically to investigate views of its implementation, acceptability and perceived benefits. Case notes of interviewed patients were analysed descriptively to assess the fidelity of G-AP implementation.ResultsG-AP was mostly implemented according to protocol with deviations noted at the planning and appraisal and feedback stages. Each stage was felt to make a useful contribution to the overall process; however, in practice, goal negotiation and goal setting merged into one stage and the appraisal and feedback stage included an explicit decision making component. Only two issues were raised regarding G-APs acceptability: (i) health professionals were concerned about the impact of goal non-attainment on patient's well-being (patients did not share their concerns), and (ii) some patients and health professionals found the patient-held record unhelpful. G-AP was felt to have a positive impact on patient goal attainment and professional goal setting practice. Collaborative partnerships between health professionals and patients were apparent throughout the process.ConclusionsG-AP has been perceived as both beneficial and broadly acceptable in one community rehabilitation team; however, implementation of novel aspects of the framework was inconsistent. The regulatory function of goal non-attainment and the importance of creating flexible partnerships with patients have been highlighted. Further development of the G-AP framework, training package and patient held record is required to address the specific issues highlighted by this process evaluation. Further evaluation of G-AP is required across diverse community rehabilitation settings.

Project description:ObjectivesThe study aims to evaluate the impact of the Revised Health Insurance Law 2014 on the utilisation of outpatient and inpatient care services, healthcare services utilisation at different levels of providers, types of providers and types of visits across different entitlement groups.Design/settingSecondary data from two waves of the Vietnam Household Living Standard Survey (VHLSS) 2016, VHLSS 2014 were used. A cross-sectional study applying propensity score matching was conducted.ParticipantsA total of 4900 individuals who reported using healthcare services are analysed.Outcomes measureNumbers of outpatient and inpatient visits, frequency of healthcare service utilisation at commune health stations, district hospitals, provincial hospitals, public and private health facilities, number of visits at health facility for medical treatment and health checks per year.ResultsThe result indicates that health insurance (HI) policy increased the number of outpatient visits for the enrolled between 0.87 and 1.29. The greatest impact was found on participants of heavily subsidised health insurance (HSHI) programmes with 1.29 visits per person per year. Similarly, an increase between 0.08 and 0.16 in the number of inpatient admissions was because of participation in HI. With regard to type of healthcare providers, the study found that participation in HI has the most effect on the use of healthcare services at district hospitals. However, the study demonstrated that the impacts of HI on the increase in the frequency of visiting commune health stations, number of visits at the provincial hospital for HSHI groups, and number of visits at health facilities for health check and consultation were sensitive to unobserved characteristics.ConclusionOur findings imply that policy-makers in Vietnam could continue expanding health insurance coverage to increase access to healthcare services for citizens, especially vulnerable groups. In addition, the government should draw more attention to primary healthcare level.

Project description:BACKGROUND:Vietnam has a smoking prevalence that is the second highest among Southeast Asian countries (SEACs). According to the World Health Organization (WHO), most reductions in mortality from tobacco use in the near future will be achieved through helping current users quit. Yet, largely due to a lack of research on strategies for implementing WHO-endorsed treatment guidelines in primary care settings, services to treat tobacco dependence are not readily available to smokers in low middle-income countries (LMICs) like Vietnam. The objective of this study is to conduct a cluster randomized controlled trial that compares the effectiveness of two system-level strategies for implementing evidence-based guidelines for the treatment of tobacco use in 26 public community health centers (CHCs) in Vietnam. METHODS/DESIGN:The current study will use a cluster-randomized design and multiple data sources (patient exit interviews, provider and village health worker (VHW) surveys, and semi-structured provider/VHW interviews) to study the process of adapting and implementing clinical practice guidelines in Vietnam and theory-driven mechanisms hypothesized to explain the comparative effectiveness of the two strategies for implementation. CHCs will be randomly assigned to either of the following: (1) training plus clinical reminder system (TC) or (2) TC?+?referral to a VHW (TCR) for three in person counseling sessions. The primary outcome is provider adherence to tobacco use treatment guidelines. The secondary outcome is 6-month biochemically verified smoking abstinence. DISCUSSION:The proposed implementation strategies draw on evidence-based approaches and a growing literature that supports the effectiveness of integrating community health workers as members of the health care team to improve access to preventive services. We hypothesize that the value of these implementation strategies is additive and that incorporating a referral resource that allows providers to delegate the task of offering counseling (TCR) will be superior to TC alone in improving delivery of cessation assistance to smokers. The findings of this research have potential to guide large-scale adoption of promising strategies for implementing and disseminating tobacco use treatment guidelines throughout the public health system in Vietnam and will serve as a model for similar action in other LMICs. TRIAL REGISTRATION:NCT01967654.

Dataset Information

Can propensity score matching be applied to cross-sectional data to evaluate Community-Based Rehabilitation? Results of a survey implementing the WHO's Community-Based Rehabilitation indicators in Vietnam.

Objectives

Design

Setting and participants

Results

Conclusion

Publications

Can propensity score matching be applied to cross-sectional data to evaluate Community-Based Rehabilitation? Results of a survey implementing the WHO's Community-Based Rehabilitation indicators in Vietnam.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets