A MULTIPLE IMPUTATION PROCEDURE FOR RECORD LINKAGE AND CAUSAL INFERENCE TO ESTIMATE THE EFFECTS OF HOME-DELIVERED MEALS
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ABSTRACT:
SUBMITTER: Shan M
PROVIDER: S-EPMC9222523 | biostudies-literature | 2021 Mar
REPOSITORIES: biostudies-literature
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Project description:Background In patients with heart failure (HF), malnutrition and dietary sodium excess are common and may worsen outcomes. No prior studies have provided low-sodium, nutritionally complete meals following HF hospitalization. Methods and Results The GOURMET-HF study (Geriatric Out-of-Hospital Randomized Meal Trial in Heart Failure) randomized patients discharged from HF hospitalization to 4 weeks of home-delivered sodium-restricted Dietary Approaches to Stop Hypertension meals (DASH/SRD; 1500 mg sodium/d) versus usual care. The primary outcome was the between-group change in the Kansas City Cardiomyopathy Questionnaire summary score from discharge to 4 weeks postdischarge. Additional outcomes included changes in the Kansas City Cardiomyopathy Questionnaire clinical summary score and cardiac biomarkers. All patients were followed 12 weeks for death/all-cause readmission and potential diet-related adverse events (symptomatic hypotension, hyperkalemia, acute kidney injury). Sixty-six patients were randomized 1:1 at discharge to DASH/SRD versus usual care (age, 71±8 years; 30% female; ejection fraction, 39±18%). The Kansas City Cardiomyopathy Questionnaire summary score increased similarly between groups (DASH/SRD 46±23-59±20 versus usual care 43±19-53±24; P=0.38), but the Kansas City Cardiomyopathy Questionnaire clinical summary score increase tended to be greater in DASH/SRD participants (47±22-65±19 versus 45±20-55±26; P=0.053). Potentially diet-related adverse events were uncommon; 30-day HF readmissions (11% versus 27%; P=0.06) and days rehospitalized within that timeframe (17 versus 55; P=0.055) trended lower in DASH/SRD participants. Conclusions Home-delivered DASH/SRD after HF hospitalization appeared safe in selected patients and had directionally favorable effects on HF clinical status and 30-day readmissions. Larger studies are warranted to clarify the effects of postdischarge nutritional support in patients with HF. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02148679.
| S-EPMC6205816 | biostudies-literature
Project description:We consider causal inference for observational studies with data spread over two files. One file includes the treatment, outcome, and some covariates measured on a set of individuals, and the other file includes additional causally-relevant covariates measured on a partially overlapping set of individuals. By linking records in the two databases, the analyst can control for more covariates, thereby reducing the risk of bias compared to using only one file alone. When analysts do not have access to a unique identifier that enables perfect, error-free linkages, they typically rely on probabilistic record linkage to construct a single linked data set, and estimate causal effects using these linked data. This typical practice does not propagate uncertainty from imperfect linkages to the causal inferences. Further, it does not take advantage of relationships among the variables to improve the linkage quality. We address these shortcomings by fusing regression-assisted, Bayesian probabilistic record linkage with causal inference. The Markov chain Monte Carlo sampler generates multiple plausible linked data files as byproducts that analysts can use for multiple imputation inferences. Here, we show results for two causal estimators based on propensity score overlap weights. Using simulations and data from the Italy Survey on Household Income and Wealth, we show that our approach can improve the accuracy of estimated treatment effects.
| S-EPMC11283754 | biostudies-literature
Project description:Background: Setting up a home-delivered meal service often allows older people suffering from physical and/or cognitive disabilities to stay at home. However, older people who delegate their food activities (food purchasing, cooking…) have been reported to have a worse nutritional status than people who take care of their food activities. In this context, we will conduct a systematic review of all studies related to the nutritional issue in home-delivered meal older recipients. Methods: In June 2020, we searched 3 databases (Pubmed, Web of Science, EMBASE) to identify studies from all years on older adults at home and receiving home-delivered meal services (population). The following outcomes were considered: nutritional status (Body Mass Index, weight, undernutrition) and nutritional intake. Any nutritional intervention, comparator, and study design were relevant for inclusion. Results: Forty-eight original studies met the inclusion criteria, most of them being published after the year 2000 (n = 34) and undertaken in the USA (n = 32). The selection includes 30 cross-sectional and 18 longitudinal studies. The main findings of this review are the following: (1) home-delivery meal older recipients are at high risk of undernutrition; (2) providing home-delivery meals may improve the nutritional status and nutrient intake; (3) this improvement is even higher when the home-delivery meal service is improved, for instance by providing dietetic counseling or adding supplementary snacks/meals or enriched food. However, even an improved service does not allow all the older recipients meeting their recommended nutritional allowance. Conclusion: This review reveals a need to further develop strategies allowing home-delivery meal older recipients to fulfill their nutritional needs. From a methodological point of view, there is a need to describe in more detail the home-delivered services provided to studies' participants to better consider meal frequency and meal content in the results.
| S-EPMC7982843 | biostudies-literature
Project description:BackgroundHome-delivered meals promote food security, socialization, and independence among homebound older adults. However, it is unclear which of the two predominant modes of meal delivery, daily-delivered vs. drop-shipped, frozen meals, promotes community living for homebound older adults with dementia. Our objective is to present the protocol for a pilot multisite, two-arm, pragmatic feasibility trial comparing the effect of two modes of meal delivery on nursing home placement among people with dementia. We include justifications for individual randomization with different consent processes and waivers for specific elements of the trial.Methods236 individuals with dementia on waiting lists at three Meals on Wheels programs' in Florida and Texas will be randomized to receive either: 1) meals delivered multiple times per week by a Meals on Wheels volunteer or paid driver who may socialize with and provide an informal wellness check or 2) frozen meals that are mailed to participants' homes every two weeks. We will evaluate and refine processes for recruitment and randomization; assess adherence to the intervention; identify common themes in participant experience; and test processes for linking participant data with Medicare records and nursing home assessment data. We will conduct exploratory analyses examining time to nursing home placement, the primary outcome for the larger trial.ConclusionThis pilot will inform the follow-on large-scale, definitive pragmatic trial. In addition, the justifications for individual randomization with differing consent procedures for elements of a pragmatic trial provide a model for future trialists looking to develop ethical and feasible pragmatic studies enrolling people with dementia.
| S-EPMC9817376 | biostudies-literature
Project description:ImportanceHome-delivered meals promote food security and independence among homebound older adults. However, it is unclear which of the 2 predominant modes of meal delivery, daily-delivered vs mailed (or drop-shipped) frozen meals, promotes community living for homebound older adults with dementia.ObjectiveTo assess the risk of nursing home admission within 6 months between homebound individuals receiving daily-delivered vs drop-shipped frozen meals.Design, setting, and participantsThis pilot, multisite, 2-arm, pragmatic clinical trial included older adults with self-reported dementia on waiting lists for meals at 3 Meals on Wheels (MOW) programs in Texas and Florida between April 7 and October 8, 2021, to assess time to nursing home placement.InterventionsParticipants were randomized to receive either meals delivered by an MOW driver or frozen meals that were mailed to participants' homes every 2 weeks. Participants received their assigned intervention for up to 6 months.Main outcomes and measuresThe primary study outcome was days from randomization to a Minimum Data Set nursing home admission assessment within 6 months. Feasibility of conducting this type of study was examined by tracking enrollment, examining baseline characteristics, monitoring participants' intervention fidelity, measuring the proportion of participants linked with Centers for Medicare & Medicaid Services (CMS) data, and analyzing the primary study outcome.ResultsAmong 325 eligible participants who were randomized, 243 enrolled in the study (mean [SD] age, 81 [8.0] years; 152 (62.6%) were female): 128 to the daily-delivered meals group and 115 to the drop-shipped frozen meals group; 119 participants (49.0%) lived alone. Among the total participants enrolled, 227 (93.4%) were linked deterministically to their CMS data; probabilistic methods were used to link the remaining 16 participants (6.6%). At 6 months from randomization, 160 participants (65.8%) were still receiving meals, and 25 (10.1%; 95% CI, 6.3%-14.0%) were admitted to a nursing home. After adjusting for sex, race and ethnicity, age, program, and living arrangement and the use of death as a censoring event, the adjusted log hazard ratio of nursing home placement between daily-delivered and drop-shipped frozen meals was -0.67 (95% CI, -1.52 to 0.19).Conclusions and relevanceThis pilot randomized clinical trial demonstrated the feasibility of enrolling participants with self-reported dementia on waiting lists at MOW programs, linking their data, and evaluating outcomes. While this pilot study was not powered to detect meaningful, statistically significant differences in nursing home placement, its feasibility and initial results warrant exploration in a follow-on, adequately powered trial.Trial registrationClinicalTrials.gov Identifier: NCT04850781.
| S-EPMC10733798 | biostudies-literature
Project description: Not available
| S-EPMC11684594 | biostudies-literature
Project description:Nursing home bed-hold policies provide continuity of care for Medicaid beneficiaries by paying nursing homes to reserve beds so residents can return to their facility of occupancy following an acute hospitalization. In 2001, Michigan implemented bed-hold policies in nursing homes. We investigated the impact of these policies on mortality and hospitalizations using 1999-2004 quarterly data from nursing homes in Michigan and nursing homes in 11 states that did not implement such policies. Synthetic Control has been used to estimate the effects of policies by accounting for changes over time unrelated to the intervention. Synthetic Control is intended for scalar continuous outcome at each period, and assumes a single treated unit and multiple control units. We propose a Bayesian procedure to overcome these limitations. It imputes the outcomes of nursing homes in Michigan if they were not exposed to the policy by matching to non-exposed nursing homes that are associated with the exposed ones in the pre-policy period. Because sampling from a Bayesian model is computationally challenging, we describe an approximation procedure that can be implemented using existing software. Our approach can be applied to other studies that examine the impact of policies.
| S-EPMC6180940 | biostudies-literature
Project description:Studies involving the use of probabilistic record linkage are becoming increasingly common. However, the methods underpinning probabilistic record linkage are not widely taught or understood, and therefore these studies can appear to be a 'black box' research tool. In this article, we aim to describe the process of probabilistic record linkage through a simple exemplar. We first introduce the concept of deterministic linkage and contrast this with probabilistic linkage. We illustrate each step of the process using a simple exemplar and describe the data structure required to perform a probabilistic linkage. We describe the process of calculating and interpreting matched weights and how to convert matched weights into posterior probabilities of a match using Bayes theorem. We conclude this article with a brief discussion of some of the computational demands of record linkage, how you might assess the quality of your linkage algorithm, and how epidemiologists can maximize the value of their record-linked research using robust record linkage methods.
| S-EPMC5005943 | biostudies-literature
Project description:The perceptual upright is thought to be constructed by the central nervous system (CNS) as a vector sum; by combining estimates on the upright provided by the visual system and the body's inertial sensors with prior knowledge that upright is usually above the head. Recent findings furthermore show that the weighting of the respective sensory signals is proportional to their reliability, consistent with a Bayesian interpretation of a vector sum (Forced Fusion, FF). However, violations of FF have also been reported, suggesting that the CNS may rely on a single sensory system (Cue Capture, CC), or choose to process sensory signals based on inferred signal causality (Causal Inference, CI). We developed a novel alternative-reality system to manipulate visual and physical tilt independently. We tasked participants (n?=?36) to indicate the perceived upright for various (in-)congruent combinations of visual-inertial stimuli, and compared models based on their agreement with the data. The results favor the CI model over FF, although this effect became unambiguous only for large discrepancies (±60°). We conclude that the notion of a vector sum does not provide a comprehensive explanation of the perception of the upright, and that CI offers a better alternative.
| S-EPMC5882842 | biostudies-other
Project description:Programs that help older adults live independently in the community can also deliver net savings to states on the costs of long-term supports and services. We estimate that if all states had increased by 1 percent the number of adults age sixty-five or older who received home-delivered meals in 2009 under Title III of the Older Americans Act, total annual savings to states' Medicaid programs could have exceeded $109 million. The projected savings primarily reflect decreased Medicaid spending for an estimated 1,722 older adults with low care needs who would no longer require nursing home care--instead, they could remain at home, sustained by home-delivered meals. Twenty-six states could have realized net savings in 2009 from the expansion of their home-delivered meals programs, while twenty-two states would have incurred net costs. Programs such as home-delivered meals have the potential to provide substantial savings to some states' Medicaid programs.
| S-EPMC4001076 | biostudies-literature