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Logo of bmcmrmBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Medical Research Methodology
BMC Med Res Methodol. 2012; 12: 23.
Published online Mar 9, 2012. doi:  10.1186/1471-2288-12-23
PMCID: PMC3348070
Comparative effectiveness research on patients with acute ischemic stroke using Markov decision processes
Darong Wu,1,2 Yefeng Cai,1 Jianxiong Cai,1,2 Qiuli Liu,3 Yuanqi Zhao,1 Jingheng Cai,4 Min Zhao,1 Yonghui Huang,4 Liuer Ye,4 Yubo Lu,1,2 and Xianping Guocorresponding author4,5
1The 2nd Clinical Medical College of Guangzhou University of Chinese Medicine, the 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
2Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
3South China Normal University, Guangzhou, China
4Sun Yat-Sen University, Guangzhou, China
5School of Mathematics and Computational Science, Sun Yat-Sen University, 135, Xingangxi Road, Haizhu District, Guangzhou, Guangdong, China
corresponding authorCorresponding author.
Darong Wu: drdarongwu/at/; Yefeng Cai: caiyefeng/at/; Jianxiong Cai: lacus826/at/; Qiuli Liu: liuql2007/at/; Yuanqi Zhao: tcmtcm2008/at/; Jingheng Cai: caijheng/at/; Min Zhao: cassiesandra/at/; Yonghui Huang: hyongh5/at/; Liuer Ye: yeliuer/at/; Yubo Lu: lyuanzhang/at/; Xianping Guo: mcsgxp/at/
Received May 16, 2011; Accepted March 9, 2012.
Several methodological issues with non-randomized comparative clinical studies have been raised, one of which is whether the methods used can adequately identify uncertainties that evolve dynamically with time in real-world systems. The objective of this study is to compare the effectiveness of different combinations of Traditional Chinese Medicine (TCM) treatments and combinations of TCM and Western medicine interventions in patients with acute ischemic stroke (AIS) by using Markov decision process (MDP) theory. MDP theory appears to be a promising new method for use in comparative effectiveness research.
The electronic health records (EHR) of patients with AIS hospitalized at the 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine between May 2005 and July 2008 were collected. Each record was portioned into two "state-action-reward" stages divided by three time points: the first, third, and last day of hospital stay. We used the well-developed optimality technique in MDP theory with the finite horizon criterion to make the dynamic comparison of different treatment combinations.
A total of 1504 records with a primary diagnosis of AIS were identified. Only states with more than 10 (including 10) patients' information were included, which gave 960 records to be enrolled in the MDP model. Optimal combinations were obtained for 30 types of patient condition.
MDP theory makes it possible to dynamically compare the effectiveness of different combinations of treatments. However, the optimal interventions obtained by the MDP theory here require further validation in clinical practice. Further exploratory studies with MDP theory in other areas in which complex interventions are common would be worthwhile.
Keywords: Markov decision processes, Acute ischemic stoke, Comparative effectiveness research, Traditional Chinese Medicine/integrative medicine
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