Comparative Effectiveness Research Of Different Combinations Of Treatments Interventions In Patients Of Stroke At Convalescence Stage Based On Markov Decision Process

Objective The objective of this study is to compare the effectiveness of different combinations interventions in patients with stroke at convalescence stage by basing on the electronic health record system(EHRs)and using Markov decision process theory and to explore the feasibility of the Markov model.Methods Through the EHRS,filtered the patients with stroke at convalescence stage during hospitalization admitted to the Third Affiliated Hospital of Zhejiang Chinese Medical University from January 2012 to January 2017 were screened.And according to the Markov model,the relevant clinical data was extracted and made the appropriate conversion(state-action-reward).Then the transition probability of each state was calculated and started the Markov decision process(MDP)analysis.By the Monte Carlo simulation method,it got the best interventions.Results 1.Cases analysis:(1)A total of 835 patients with stroke convalescence stage was identified.501 were males,accounting for 60.00%,and 334 were females,accounting for 40.00%.(2)The largest proportion of patients aged ≥66 years was about 63.83%.(3)Only 9.10% of patients had no previous history of risk factors such as hypertension or diabetes.About 73.53% patients were without complication.(4)There were 637 ischemic strokes,accounting for 76.29%,and 198 cases of hemorrhagic stroke,accounting for23.71%.(5)About the syndrome differentiation,the largest number of patients was phlegm and blood stasis,the second was qi deficiency and blood stasis.(6)Most patients had moderate to severe neurological impairment.2.Markov decision analysis:(1)When the patients with stroke at convalescence stage has a medical history but no complications,mild neurological impairment,≥66 years and18-45 years old patients are advised to choose acupuncture treatment.46-65 years old patients are advised to choose rehabilitation treatment.When patients with moderate to severe neurological impairment,patients are advised to choose rehabilitation,Chinese herbal decoction and acupuncture combined therapy.(2)Patients who have no complications and ≥66 years old,when there is no medical history,are recommended to choose rehabilitation treatment when mild impairment of nerve function;Rehabilitation and acupuncture treatment are recommended when moderate and severe injuries.(3)The combination of rehabilitation,Chinese herbal decoction and acupuncture treatment is recommended for patients with phlegm and blood stasis.Acupuncture treatment is recommended for patients with mild impairment of nerve function in qi deficiency and blood stasis type.Rehabilitation,Chinese herbal decoction and acupuncture treatment is recommended for moderate-severe injuries.Conclusion 1.MDP makes it possible to study the effectiveness of different treatment methods in stroke patients who at convalescence stage.2.Patients with mild neurological impairment during stroke at convalescence stage are recommended to choose acupuncture or rehabilitation according to different age groups.3.When the nerve function is moderately to severely injured,it is recommended to choose rehabilitation,Chinese herbal decoction and acupuncture combined therapy.4.The combination of rehabilitation,Chinese herbal decoction and acupuncture treatment is recommended for patients with phlegm and blood stasis.Acupuncture treatment is recommended for patients with mild impairment of nerve function in qi deficiency and blood stasis type.