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      Harnessing EHR data for health research.

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          Abstract

          With the increasing availability of rich, longitudinal, real-world clinical data recorded in electronic health records (EHRs) for millions of patients, there is a growing interest in leveraging these records to improve the understanding of human health and disease and translate these insights into clinical applications. However, there is also a need to consider the limitations of these data due to various biases and to understand the impact of missing information. Recognizing and addressing these limitations can inform the design and interpretation of EHR-based informatics studies that avoid confusing or incorrect conclusions, particularly when applied to population or precision medicine. Here we discuss key considerations in the design, implementation and interpretation of EHR-based informatics studies, drawing from examples in the literature across hypothesis generation, hypothesis testing and machine learning applications. We outline the growing opportunities for EHR-based informatics studies, including association studies and predictive modeling, enabled by evolving AI capabilities-while addressing limitations and potential pitfalls to avoid.

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          Is Open Access

          UK Biobank: An Open Access Resource for Identifying the Causes of a Wide Range of Complex Diseases of Middle and Old Age

          Cathie Sudlow and colleagues describe the UK Biobank, a large population-based prospective study, established to allow investigation of the genetic and non-genetic determinants of the diseases of middle and old age.
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            An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies

            The propensity score is the probability of treatment assignment conditional on observed baseline characteristics. The propensity score allows one to design and analyze an observational (nonrandomized) study so that it mimics some of the particular characteristics of a randomized controlled trial. In particular, the propensity score is a balancing score: conditional on the propensity score, the distribution of observed baseline covariates will be similar between treated and untreated subjects. I describe 4 different propensity score methods: matching on the propensity score, stratification on the propensity score, inverse probability of treatment weighting using the propensity score, and covariate adjustment using the propensity score. I describe balance diagnostics for examining whether the propensity score model has been adequately specified. Furthermore, I discuss differences between regression-based methods and propensity score-based methods for the analysis of observational data. I describe different causal average treatment effects and their relationship with propensity score analyses.
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              MatchIt: Nonparametric Preprocessing for Parametric Causal Inference

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                Author and article information

                Journal
                Nat Med
                Nature medicine
                Springer Science and Business Media LLC
                1546-170X
                1078-8956
                Jul 2024
                : 30
                : 7
                Affiliations
                [1 ] Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA.
                [2 ] Qualified Health, Palo Alto, CA, USA.
                [3 ] Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA. marina.sirota@ucsf.edu.
                [4 ] Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA. marina.sirota@ucsf.edu.
                Article
                10.1038/s41591-024-03074-8
                10.1038/s41591-024-03074-8
                38965433
                9ab67954-1ed0-463e-8808-52292431a614
                History

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