A Markov chain model used in analyzing disease history applied to a stroke study

In clinical research, study subjects may experience multiple events that are observed and recorded periodically. To analyze transition patterns of disease processes, it is desirable to use those multiple events over time in the analysis. This study proposes a multi-state Markov model with piecewise transition probability, which is able to accommodate periodically observed clinical data without a time homogeneity assumption. Models with ordinal outcomes that incorporate covariates are also discussed. The proposed models are illustrated by an analysis of the severity of morbidity in a monthly follow-up study for patients with spontaneous intracerebral hemorrhage.