Health care is a complex system and it is therefore expected to behave in a non-linear manner. It is important for the delivery of health interventions to patients that the best possible analysis of available data is undertaken. Many of the conventional models used for health care data are linear. This research compares the performance of linear models with non-linear models for two health care data sets of complex interventions. Logistic regression, latent class analysis and a classification artificial neural network were each used to model outcomes for patients using data from a randomised controlled trial of a cognitive behavioural complex intervention for non-specific low back pain. A Cox proportional hazards model and an artificial neural network were used to model survival and the hazards for different sub-groups of patients using an observational study of a cardiovascular rehabilitation complex intervention. The artificial neural network and an ordinary logistic regression were more accurate in classifying patient recovery from back pain than a logistic regression on latent class membership. The most sensitive models were the artificial neural network and the latent class logistic regression. The best overall performance was the artificial neural network, providing both sensitivity and accuracy. Survival was modelled equally well by the Cox model and the artificial neural network, when compared to the empirical Kaplan-Meier survival curve. Long term survival for the cardiovascular patients was strongly associated with secondary prevention medications, and fitness was also important. Moreover, improvement in fitness during the rehabilitation period to a fairly modest 'high fitness' category was as advantageous for long-term survival as having achieved that same level of fitness by the beginning of the rehabilitation period. Having adjusted for fitness, BMI was not a predictor of long term survival after a cardiac event or procedure. The Cox proportional hazards model was constrained by its assumptions to produce hazard trajectories proportional to the baseline hazard. The artificial neural network model produced hazard trajectories that vary, giving rise to hypotheses about how the predictors of survival interact in their influence on the hazard. The artificial neural network, an exemplar non-linear model, has been shown to match or exceed the capability of conventional models in the analysis of complex health care data sets.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:589827 |
| Date | January 2013 |
| Creators | Barons, Martine J. |
| Publisher | University of Warwick |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://wrap.warwick.ac.uk/58401/ |
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