Bayesian nonparametric policy search with application to periodontal recall intervals
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Publication:5120645
DOI10.1080/01621459.2019.1660169zbMATH Open1441.62362arXiv1810.04338OpenAlexW2972414773WikidataQ100433991 ScholiaQ100433991MaRDI QIDQ5120645FDOQ5120645
Authors: Qian Guan, Brian J. Reich, Eric B. Laber, Dipankar Bandyopadhyay 
Publication date: 15 September 2020
Published in: Journal of the American Statistical Association (Search for Journal in Brave)
Abstract: 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 non-parametric 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.
Full work available at URL: https://arxiv.org/abs/1810.04338
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observational dataperiodontal diseaseprecision medicinedynamic treatment regimesDirichlet process priorsequential optimizationpractice-based setting
Bayesian inference (62F15) Applications of statistics to biology and medical sciences; meta analysis (62P10)
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Cited In (6)
- Estimating optimal dynamic treatment strategies under resource constraints using dynamic marginal structural models
- CAPITAL: optimal subgroup identification via constrained policy tree search
- Bayesian inference for optimal dynamic treatment regimes in practice
- Personalized dynamic treatment regimes in continuous time: a Bayesian approach for optimizing clinical decisions with timing
- Deep spectral Q-learning with application to mobile health
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