Uncovering Interpretable Potential Confounders in Electronic Medical Records

Jiaming Zeng, Michael F. Gensheimer, Daniel L. Rubin, Susan Athey and Ross D. Schachter
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Jiaming Zeng: Stanford University
Michael F. Gensheimer: Stanford University
Daniel L. Rubin: Stanford University
Ross D. Schachter: Stanford University

Research Papers from Stanford University, Graduate School of Business

Abstract: In medicine, randomized clinical trials are the gold standard for informing treatment decisions. Observational comparative effectiveness research is often plagued by selection bias, and expert-selected covariates may not be sufficient to adjust for confounding. We explore how the unstructured clinical text in electronic medical records can be used to reduce selection bias and improve medical practice. We develop a method based on natural language processing to uncover interpretable potential confounders from the clinical text. We validate our method by comparing the hazard ratio (HR) from survival analysis with and without the confounders against the results from established RCTs. We apply our method to four study cohorts built from localized prostate and lung cancer datasets from the Stanford Cancer Institute Research Database and show that our method adjusts the HR estimate towards the RCT results. We further confirm that the uncovered terms can be interpreted by an oncologist as potential confounders. This research helps enable more credible causal inference using data from EMRs, offers a transparent way to improve the design of observational CER, and could inform high-stake medical decisions. Our method can also be applied to studies within and beyond medicine to extract important information from observational data to support decisions.

Date: 2021-02
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Journal Article: Uncovering interpretable potential confounders in electronic medical records (2022)
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Persistent link: https://EconPapers.repec.org/RePEc:ecl:stabus:3950

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