arXiv subjects

Jason Falvey

Publications and source records attributed to Jason Falvey.

3 recordsLinked to original sources

arXiv2026

A Novel Tool for Evaluating Effect Modification in Older Adults with ADRD Using Medicare Claims

Studying consequences following baseline exposures has become increasingly important for advancing comparative effectiveness research using real-world data. This case study evaluates the impact of hospital-acquired conditions (HAC) during hospitalization for hip fracture on post-discharge recovery trajectories among older adults living with Alzheimer Disease and Related Dementia, a population particularly vulnerable to high post-hospital mortality. To appropriately account for truncation of recovery trajectory due to death and to explore heterogeneity in effect modification by patient demographics, we introduce a novel pseudo data-based robust (PD-Robust) analysis strategy, accompanied by an R package and detailed usage guidance to inform real data analysis. Grounded in an interpretable estimand via principal stratification under principal ignorability and a structural working model, PD-Robust accommodates truncation by death, provides model diagnosis and robustness check against assumption violation, and facilitates the characterization of patient profiles among the principal stratum. Applied to Medicare claims data, where better recovery is defined as more days at home (DAH) over six months post-discharge, PD-Robust reveals heterogeneity in HAC effects, with males under the age of 85 years as a high-risk subgroup experiencing up to 23 fewer DAH, comparing HAC to no HAC. This exceeds the 8-day threshold regarded as clinically meaningful difference in DAH due to any exposure. Moreover, simulation studies further demonstrate that PD-Robust achieves low estimation bias and accurate statistical inference, supporting its utility in real-world data applications.

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arXiv2025

A New Targeted-Federated Learning Framework for Estimating Heterogeneity of Treatment Effects: A Robust Framework with Applications in Aging Cohorts

Analyzing data from multiple sources offers valuable opportunities to improve the estimation efficiency of causal estimands. However, this analysis also poses many challenges due to population heterogeneity and data privacy constraints. While several advanced methods for causal inference in federated settings have been developed in recent years, many focus on difference-based averaged causal effects and are not designed to study effect modification. In this study, we introduce a novel targeted-federated learning framework to study the heterogeneity of treatment effects (HTEs) for a targeted population by proposing a projection-based estimand. This HTE framework integrates information from multiple data sources without sharing raw data, while accounting for covariate distribution shifts among sources. Our proposed approach is shown to be doubly robust, conveniently supporting both difference-based estimands for continuous outcomes and odds ratio-based estimands for binary outcomes. Furthermore, we develop a communication-efficient bootstrap-based selection procedure to detect non-transportable data sources, thereby enhancing robust information aggregation without introducing bias. The superior performance of the proposed estimator over existing methods is demonstrated through extensive simulation studies, and the utility of our approach has been shown in a real-world data application using nationwide Medicare-linked data.

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arXiv2023

Analyzing Risk Factors for Post-Acute Recovery in Older Adults with Alzheimer's Disease and Related Dementia: A New Semi-Parametric Model for Large-Scale Medicare Claims

Nearly 300,000 older adults experience a hip fracture every year, the majority of which occur following a fall. Unfortunately, recovery after fall-related trauma such as hip fracture is poor, where older adults diagnosed with Alzheimer's Disease and Related Dementia (ADRD) spend a particularly long time in hospitals or rehabilitation facilities during the post-operative recuperation period. Because older adults value functional recovery and spending time at home versus facilities as key outcomes after hospitalization, identifying factors that influence days spent at home after hospitalization is imperative. While several individual-level factors have been identified, the characteristics of the treating hospital have recently been identified as contributors. However, few methodological rigorous approaches are available to help overcome potential sources of bias such as hospital-level unmeasured confounders, informative hospital size, and loss to follow-up due to death. This article develops a useful tool equipped with unsupervised learning to simultaneously handle statistical complexities that are often encountered in health services research, especially when using large administrative claims databases. The proposed estimator has a closed form, thus only requiring light computation load in a large-scale study. We further develop its asymptotic properties that can be used to make statistical inference in practice. Extensive simulation studies demonstrate superiority of the proposed estimator compared to existing estimators.

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