Why the study?
The study aimed to present clinicians at the point-of-care with real-world data on the effectiveness of various treatment options within a precision cohort of patients closely matched to the index patient.
Do best-practice treatment options identified by machine-learning patient-similarity models improve expected disease control in patients with HTN, T2DM, or HL compared to actual treatment decisions?
Observational (n=2,500,000)
Do best-practice treatment options identified by machine-learning patient-similarity models improve expected disease control in patients with HTN, T2DM, or HL compared to actual treatment decisions?
Machine-learning patient-similarity models can identify alternative treatment options that significantly improve expected disease control rates for hypertension, diabetes, and hyperlipidemia compared to standard care.
OBJECTIVE: To present clinicians at the point-of-care with real-world data on the effectiveness of various treatment options in a precision cohort of patients closely matched to the index patient. MATERIALS AND METHODS: We developed disease-specific, machine-learning, patient-similarity models for hypertension (HTN), type II diabetes mellitus (T2DM), and hyperlipidemia (HL) using data on approximately 2.5 million patients in a large medical group practice. For each identified decision point, an encounter during which the patient's condition was not controlled, we compared the actual outcome of the treatment decision administered to that of the best-achieved outcome for similar patients in similar clinical situations. RESULTS: For the majority of decision points (66.8%, 59.0%, and 83.5% for HTN, T2DM, and HL, respectively), there were alternative treatment options administered to patients in the precision cohort that resulted in a significantly increased proportion of patients under control than the treatment option chosen for the index patient. The expected percentage of patients whose condition would have been controlled if the best-practice treatment option had been chosen would have been better than the actual percentage by: 36% (65.1% vs 48.0%, HTN), 68% (37.7% vs 22.5%, T2DM), and 138% (75.3% vs 31.7%, HL). CONCLUSION: Clinical guidelines are primarily based on the results of randomized controlled trials, which apply to a homogeneous subject population. Providing the effectiveness of various treatment options used in a precision cohort of patients similar to the index patient can provide complementary information to tailor guideline recommendations for individual patients and potentially improve outcomes.
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Tang et al. (2020) conducted an observational in Hypertension, type II diabetes mellitus, and hyperlipidemia (n=2,500,000). Patient-similarity models for treatment selection vs. Actual treatment decision administered was evaluated on Proportion of patients under control.
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