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Decisions 40-44: build notes for simulator and calibration

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Co-Authored-By: Claude Opus 5.5 <[email protected]>
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chendun1995
2026-10-27 08:15:30 -04:00
co-authored by Claude Opus 5.5
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@@ -81,3 +81,13 @@ Each decision is listed with the date and the reason for it. Settled decisions a
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| 38 | **No data-quality aim.** The paper keeps the three aims of the plan. Claims data problems such as time-zero misdating, physician attribution, laterality and Medicare Advantage switching are not modelled. | Focus. Papers 1 and 2 of `tte-papers` have stopped. |
| 39 | **Paper 1's comparison of adjustment methods and covariate vibration stay out** (see D26). | This paper is about which question each design answers. |
## Build notes: simulator and calibration (2026-10-27)
| # | Decision | Why |
|---|---|---|
| 40 | **Factor 5 (unmeasured confounding by indication): "off" means the analyst sees true severity Z_t, true frailty and true smoking. "On" means the analyst sees only claims proxies:** a 3-month visit/testing count for severity, a frailty index with reliability 0.4, and coded smoking (sensitivity 0.6). | In the clean worlds every confounder must be measured, so each method can be checked as unbiased for its own estimand. |
| 41 | **Each world's intercepts are re-solved by calibration (early PVI, deferred PVI, repeat revascularization, CLTI, death) so that every world matches the same Medicare targets.** A world differs from W0 only in the threat it switches on. | A fair comparison between worlds. |
| 42 | **Deferral:** in W0–W3, W5 and WR, deferred PVI matches Sorber (3.6% late PVI among patients without early PVI). **W4 is calibrated to 15%**, which is trial-like crossover, and in W4 deferral is driven by severity. In WR, deferral is at the Sorber rate but driven by severity. PVI after CLTI was lowered to about 1% per month, so most late PVI is elective. | At the Medicare rate, the deferral threat would be almost invisible. Trials (SUPER 29% in year 1) show much more crossover. |
| 43 | **Physician style coefficient 1.6** (W2, W3, WR). Among physicians with ≥11 patients this gives a median early-PVI rate of 0.8%, a maximum of 75%, and 4.7% of physicians ≥2 SD outliers who perform 38% of early PVIs. Hicks 2020 reported 0%, 58% and 5.6%. | Close enough to Hicks 2020. Not tuned further. |
| 44 | **Within a month the order is:** severity update → outcome events → death → elective PVI decision. A MALE event and death in the same month count the MALE event first. | Matches discrete-time pooled logistic analysis. |