Characterizing treatment pathways at scale using the OHDSI network
Characterizing treatment pathways at scale using the OHDSI network
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DOI：
10.1073/pnas.1510502113
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发表时间：
2016-07-05
影响因子：
11.1
通讯作者：
Madigan, David
中科院分区：
文献类型：
--
作者：
Hripcsak, George;Ryan, Patrick B.;Madigan, David
观察性研究承诺通过提供大量的、多样化的群体来补充实验研究，这些群体对于实验来说是不可行的。观察性研究可以检验自己的临床假说，观察性研究也可以帮助设计实验，并告知实验研究的普适性。了解人口的多样性和护理的差异是一个组成部分。在这项研究中，观察性健康数据科学和信息学(OHDSI)合作创建了一个国际数据网络，包含来自四个国家的11个数据源，包括2.5亿患者的电子健康记录和行政索赔数据。所有数据都映射到通用数据标准，使用分布式模型维护患者隐私，并集中汇总结果。阐明了2型糖尿病、高血压和抑郁症的治疗途径。这些途径表明，随着时间的推移，世界正在朝着跨疾病和跨地点更一致的治疗方向发展，但来源之间仍然存在显著的异质性，这表明在推广临床试验结果方面存在挑战。与高血压或抑郁症相比，糖尿病更倾向于单一的一线药物--二甲双胍。约10%的糖尿病和抑郁症患者以及近25%的高血压患者遵循在队列中独一无二的治疗路径。除了样本大小和潜在人群(学术医疗中心与普通人群)等因素外，电子健康记录数据和行政索赔数据也显示了类似的结果。大规模的国际观测研究是可行的。
Observational research promises to complement experimental research by providing large, diverse populations that would be infeasible for an experiment. Observational research can test its own clinical hypotheses, and observational studies also can contribute to the design of experiments and inform the generalizability of experimental research. Understanding the diversity of populations and the variance in care is one component. In this study, the Observational Health Data Sciences and Informatics (OHDSI) collaboration created an international data network with 11 data sources from four countries, including electronic health records and administrative claims data on 250 million patients. All data were mapped to common data standards, patient privacy was maintained by using a distributed model, and results were aggregated centrally. Treatment pathways were elucidated for type 2 diabetes mellitus, hypertension, and depression. The pathways revealed that the world is moving toward more consistent therapy over time across diseases and across locations, but significant heterogeneity remains among sources, pointing to challenges in generalizing clinical trial results. Diabetes favored a single first-line medication, metformin, to a much greater extent than hypertension or depression. About 10% of diabetes and depression patients and almost 25% of hypertension patients followed a treatment pathway that was unique within the cohort. Aside from factors such as sample size and underlying population (academic medical center versus general population), electronic health records data and administrative claims data revealed similar results. Large-scale international observational research is feasible.