Multivariate CART for survival with dental applications

多元 CART 用于牙科应用的生存

• 批准号: 8040651
• 负责人: MARTHA E NUNN
• 金额: $ 23.02万
• 依托单位: CREIGHTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-01 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8040651
• 关键词: 18 year old; Address; Adoption; Adult; Age; Behavioral; Child; Classification; Clinic; Clinical; Communities; Computational algorithm; Data; Databases; Dental; Dental Clinics; Dental Hygiene; Dental Insurance; Dental Records; Dental caries; Dentists; Dentition; Development; Electronics; Failure; Frequencies; Gender; General Population; Goals; Grant; Health Insurance Reimbursement; Health Professional; Judgment; Lead; Longevity; Measures; Medical; Medical History; Methods; Modeling; Oral cavity; Oral health; Outcome; Patients; Periodontal Diseases; Persons; Probability; Procedures; Public Health; Race; Records; Research; Resources; School Dentistry; Self Care; Smoking; Specialist; System; Testing; Third-Party Payer; Time; Tooth Loss; Tooth structure; Translations; Trees; Universities; Visit; Woman; Work; base; clinical practice; clinically significant; cost; evidence base; expectation; follow-up; forest; improved; longitudinal database; men; outcome forecast; prevent; prognostic indicator; restoration; restoration placement; success; treatment planning

DESCRIPTION (provided by applicant): Tooth loss from periodontal disease or dental caries afflicts most adults over the course of their lives. Goals of professional dental treatment and of personal oral health self-care are to prevent tooth loss and maintain the natural dentition in a state of comfort and function. In order to develop appropriate dental treatment planning, dental health care professionals must weigh the long-term outlook for retention of each tooth against the cost and discomfort involved with each treatment option, and patients and third-party payers must make value judgments about the cost of suggested dental treatments against the probability of long-term success for those treatments. Hence, it is essential to utilize dental prognosis in the development of any dental treatment plan. Goals: The primary goal of this study is to apply newly developed multivariate extensions of Classification And Regression Trees (CART) for survival to a large, de-identified database obtained from the AxiUm system of electronic dental records at Creighton University School of Dentistry to establish global dental prognostic indicators based on actual tooth loss. We also plan to refine computer algorithms we developed for multivariate CART for survival to increase computing efficiency and further extend Bayesian survival trees and random forests to correlated outcomes in order to utilize the most accurate procedure for establishing criteria for assignment of dental prognosis Subjects: The hypotheses will be tested on a 4-year longitudinal database consisting of 19,092 men, women, and children with follow-up data who have been treated at the Creighton University dental clinic. Of the 19,092 patients with follow-up data, 4,339 adults are regular patients in the periodontal clinic with follow-up periodontal records while 1,681 are children under 18 years of age. Available data for testing hypotheses: Data for age, gender, race in some records, time until tooth loss, complete restorative and periodontal records with follow-up, significant medical history, smoking, oral hygiene, special needs, compliance, frequency of dental visits and other parameters that are collected as part of dental treatment and follow-up at the Creighton University School of Dentistry. Significance: By establishing clear, objective criteria for assignment of accurate, evidence-based global dental prognostic indicators that are based on actual tooth loss, this study has the potential to make a tremendous impact on the dental community. Adoption and use of accurate, evidence-based global dental prognostic indicators could aid dental practitioners in better treatment planning, help third-party payment plans make better decisions about benefits, and provide patients with an avenue for making informed decisions about their dental treatment needs. PUBLIC HEALTH RELEVANCE: The objective of this proposal is to identify simple, objective clinical criteria for assignment of global dental prognostic indicators that are based on actual tooth loss. The central hypothesis is that commonly used clinical measures can be used to forecast the long-term prognosis of any tooth in a patient's mouth at any given time. Development, adoption, and use of accurate, evidence-based global dental prognostic indicators has the potential for making a significant public health impact by aiding dental practitioners in better treatment planning, helping third-party payment plans make better decisions about benefits, and providing patients objective criteria for making informed decisions about their dental treatment needs.

描述（由申请人提供）：牙周病或龋齿导致的牙齿脱落困扰着大多数成年人的一生。专业牙科治疗和个人口腔健康自我护理的目标是防止牙齿脱落并保持天然牙列处于舒适和功能状态。为了制定适当的牙科治疗计划，牙科保健专业人员必须权衡每颗牙齿保留的长期前景与每种治疗方案所涉及的成本和不适，患者和第三方付款人必须根据这些治疗的长期成功概率对建议的牙科治疗的成本做出价值判断。因此，在制定任何牙科治疗计划时利用牙科预后至关重要。目标：本研究的主要目标是将新开发的生存分类与回归树 (CART) 多元扩展应用到从克赖顿大学牙科学院电子牙科记录 AxiUm 系统获得的大型去识别化数据库中，以建立基于实际牙齿缺失的全球牙科预后指标。我们还计划完善为生存多变量 CART 开发的计算机算法，以提高计算效率，并进一步将贝叶斯生存树和随机森林扩展到相关结果，以便利用最准确的程序来建立牙齿预后分配标准。 受试者：这些假设将在一个为期 4 年的纵向数据库上进行测试，该数据库包含 19,092 名男性、女性和儿童的随访数据，这些数据包括： 已在克赖顿大学牙科诊所接受治疗。在19,092名有随访数据的患者中，4,339名成人是牙周诊所的常客，有牙周随访记录，1,681名是18岁以下儿童。用于测试假设的可用数据：某些记录中的年龄、性别、种族数据、牙齿脱落前的时间、完整的修复和牙周记录及随访、重要病史、吸烟、口腔卫生、特殊需求、依从性、看牙医的频率以及作为克赖顿大学牙科学院牙科治疗和随访的一部分收集的其他参数。意义：通过建立明确、客观的标准来分配基于实际牙齿缺失的准确、基于证据的全球牙科预后指标，这项研究有可能对牙科界产生巨大影响。采用和使用准确的、基于证据的全球牙科预后指标可以帮助牙医制定更好的治疗计划，帮助第三方支付计划做出更好的福利决策，并为患者提供就其牙科治疗需求做出明智决策的途径。 公共健康相关性：该提案的目的是确定简单、客观的临床标准，用于基于实际牙齿缺失的全球牙科预后指标的分配。中心假设是常用的临床测量可用于预测患者口腔中任何牙齿在任何给定时间的长期预后。开发、采用和使用准确的、基于证据的全球牙科预后指标有可能对公共健康产生重大影响，帮助牙医制定更好的治疗计划，帮助第三方支付计划做出更好的福利决策，并为患者提供客观标准，以便就其牙科治疗需求做出明智的决策。