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A methodological framework for tackling confounding by indication when assessing the treatment effects of Chinese herbal injections in the real world

A methodological framework for tackling confounding by indication when assessing the treatment... INTRODUCTIONChinese herbal injections (CHIs), widely used to treat various diseases,1 are usually administered through multiple routes and often given in combination with pharmaceutical drugs to heterogeneous patient populations.2 As such, their safety and effectiveness in real‐world practice have become important issues that warrant substantial efforts to both improve the practice of traditional Chinese medicine (TCM) and ensure patient safety.2,3 However, there is a paucity of high‐quality evidence about the treatment effects of CHIs in real‐world practice.4In recent years, routinely collected health care data (RCD), such as electronic medical records (EMRs), have become an irreplaceable source of information for assessing the real‐world treatment effects of CHIs, especially in exploring the optimal treatment patterns and the timing of CHIs among heterogeneously treated populations.5–7 Although RCD share apparent advantages in sample sizes, representative population, and high‐dimensional variables, these data are, in their nature, observational.8 Consequently, the resulting treatment effects of CHIs are usually threatened by a diversity of potential biases. One particular concern is confounding by indication (i.e., indication bias).9Confounding by indication is a highly prevalent problem in the assessment of treatment effects of Chinese herbal medicines. This is inherent with the health care setting in the context of integrative medicine. There http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Evidence Based Medicine Wiley

A methodological framework for tackling confounding by indication when assessing the treatment effects of Chinese herbal injections in the real world

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References (39)

Publisher
Wiley
Copyright
© 2022 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd
ISSN
1756-5383
eISSN
1756-5391
DOI
10.1111/jebm.12462
Publisher site
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Abstract

INTRODUCTIONChinese herbal injections (CHIs), widely used to treat various diseases,1 are usually administered through multiple routes and often given in combination with pharmaceutical drugs to heterogeneous patient populations.2 As such, their safety and effectiveness in real‐world practice have become important issues that warrant substantial efforts to both improve the practice of traditional Chinese medicine (TCM) and ensure patient safety.2,3 However, there is a paucity of high‐quality evidence about the treatment effects of CHIs in real‐world practice.4In recent years, routinely collected health care data (RCD), such as electronic medical records (EMRs), have become an irreplaceable source of information for assessing the real‐world treatment effects of CHIs, especially in exploring the optimal treatment patterns and the timing of CHIs among heterogeneously treated populations.5–7 Although RCD share apparent advantages in sample sizes, representative population, and high‐dimensional variables, these data are, in their nature, observational.8 Consequently, the resulting treatment effects of CHIs are usually threatened by a diversity of potential biases. One particular concern is confounding by indication (i.e., indication bias).9Confounding by indication is a highly prevalent problem in the assessment of treatment effects of Chinese herbal medicines. This is inherent with the health care setting in the context of integrative medicine. There

Journal

Journal of Evidence Based Medicine – Wiley

Published: Mar 1, 2022

Keywords: Chinese herbal injection; indication bias; real‐world setting; treatment effects

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