通过电子健康记录对治疗分配的因果公正性评估
Linying Zhang1, Lauren R Richter1, Yixin Wang2
1Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA.
Journal of biomedical informatics
|May 23, 2024
概括
这项研究引入了一种新的因果公平算法,用于评估电子健康记录中的治疗分配差异. 调查结果显示,在冠状动脉旁路移植中,女性和黑人患者的代表性明显不足,这表明潜在的临床不公平.
科学领域:
- 医疗保健公平和临床决策.
- 医疗AI中的因果推断和偏见缓解.
- 使用电子健康记录进行健康差异研究.
背景情况:
- 医疗保健系统面临着持续的治疗分配差异.
- 基于因果关系的公平性指标提供了一个强大的方法来缓解混偏见.
- 关于将因果公平性应用于用于临床决策的电子健康记录 (EHR) 数据的研究有限.
研究的目的:
- 解决使用EHR数据评估治疗分配因果关系公平性的方法差距.
- 调查健康的社会决定因素对因果公平性评估的影响.
- 开发和应用一种新的因果公平算法来评估临床治疗分配.
主要方法:
- 提出了一个因果公平算法来评估临床决策中的公平性.
- 考虑到患者群体的异质性和从治疗中受益的可能性.
- 将框架应用于来自EHR数据库的冠状动脉疾病患者队列.
主要成果:
- 在冠状动脉旁路移植 (CABG) 的分配中发现了显著的差异.
- 女性接受CABG的可能性比男性低4.4%-7.7%.
- 黑人或非裔美国患者接受CABG的可能性比其他患者低5.4%-8.7%,即使控制了健康的社会决定因素.
结论:
- 引入了一种新的方法来评估使用EHR数据和因果推理来评估治疗分配的公平性.
- 证明了在类似患者之间治疗分配的差异存在.
- 强调因果关系在量化和解决医疗保健中的治疗公平性方面的关键作用.
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