Using data science to measure the impact of opioid agonist therapy in patients admitted with Staphylococcus aureus bloodstream infections

项目摘要/摘要 这项职业发展奖将为INFEC管理层的调查提供早期职业支持- 在医院的成瘾环境中的常见疾病。该奖项将为候选人的发展提供支持 在以下领域有专长：1)成瘾科学研究；2)自然语言处理；3)机器学习- ING；4)专业发展；5)负责任的研究行为。为此，古德曼-梅扎博士将 由一个在成瘾、传染病和数据方面拥有专业知识的多学科、跨机构团队提供指导 科学。他的主要导师史蒂夫·肖普托博士在与成瘾相关的研究和研究方面有着广泛的记录 培训未来的独立调查人员。他的共同导师包括Alex Bui博士和Matthew B.Goetz博士。Dr。 BUI是生物医学数据科学方面的专家，负责该领域的NIH培训项目。Goetz博士有广泛的 退伍军人健康管理局(VHA)内生产性传染病临床研究的经验。 美国目前的阿片类药物流行与感染增加有关，特别是 丙型肝炎和细菌感染。细菌感染是导致住院的主要传染病诊断- 在有阿片类药物使用障碍(OUD)的个人中进行治疗，并产生大量的医疗支出。尽管 美沙酮或丁丙诺啡形式的阿片激动剂疗法(OAT)的可获得性不到20% 患有OUD的人实际上会收到燕麦片。因细菌感染住院可能是开始 燕麦片，但这种做法的好处是未知的。在这份提案中，候选人将评估 在因金黄色葡萄球菌血流而进入VHA的注射阿片类药物的人中启动燕麦疗法 感染(菌血症)-注射阿片类药物的人中最常见的细菌病原体。使用数据 已经从VHA电子数据库收集了36,868例金黄色葡萄球菌菌血症(SAB)， 候选人将解决三个研究问题：1)自然语言处理算法(NLP)是否更符合 比基于国际疾病分类(ICD)代码的标准方法更好地筛选病历 正确识别在入院的SAB患者队列中注射阿片类药物的个人；2)什么是 在该设施注射阿片类药物和接受燕麦片治疗的人中SAB的时间和地理趋势- 水平；以及3)使用机器学习框架，估计OAT对以患者为中心的影响 结果--死亡、重新入院、违背医疗建议离开，以及随后的门诊参与 燕麦。这些形成的数据将帮助应聘者建立一个富有成效的早期职业生涯，成为一名内科科学家 并建议制定燕麦片递送战略，以减少注射阿片类药物使用的感染性并发症。 通过这个奖项，古德曼-梅扎博士将成为十字路口的内科专家兼科学家。 传染病和成瘾方面的研究，准备为这一重要的医学领域做出重大贡献。

PROJECT SUMMARY/ABSTRACT This career development award will provide early career support for investigation of the management of infec- tious diseases in the setting of addiction in hospitals. The award will provide support for the candidate to develop expertise in the following areas: 1) addiction science research; 2) natural language processing; 3) machine learn- ing; 4) professional development; and 5) responsible conduct of research. For this, Dr. Goodman-Meza will be mentored by a multidisciplinary, cross-institutional team with expertise in addiction, infectious diseases, and data science. His primary mentor, Dr. Steve Shoptaw, has an extensive track record in addiction-related research and training of future independent investigators. His co-mentors include Dr. Alex Bui and Dr. Matthew B. Goetz. Dr. Bui is an expert in biomedical data science and heads NIH training programs in this field. Dr. Goetz has broad experience of productive infectious diseases clinical research within the Veterans Health Administration (VHA). The current opioid epidemic in the United States has been associated with an increase in infections, in particular hepatitis C and bacterial infections. Bacterial infections are the leading infectious diagnosis leading to hospitali- zation in individuals with an opioid use disorder (OUD), and incur significant healthcare expenditures. Despite the availability of opioid agonist therapy (OAT) in the form of methadone or buprenorphine, less than 20% of people with OUD actually receive OAT. Hospitalization for a bacterial infection may be an ideal time to initiate OAT, but the benefits of this practice are unknown. In this proposal, the candidate will assess the impact of initiating OAT in people who inject opioids admitted to the VHA due to a Staphylococcus aureus blood stream infection (bacteremia) – the most common bacterial pathogen among people who inject opioids. Using data already collected for 36,868 cases of S. aureus bacteremia (SAB) from the VHA electronic data repository, the candidate will address three research questions: 1) is a natural language processing algorithm (NLP) more ac- curate than a standard International Classification of Diseases (ICD) code-based approach at screening records to correctly identify individuals who inject opioids in a cohort of patients admitted with SAB; 2) what are the temporal and geographic trends of SAB in people who inject opioids and those who receive OAT at the facility- level; and 3) using a machine learning framework, what are the estimated impacts of OAT on patient centered outcomes – death, readmissions, leaving against medical advice, and subsequent outpatient engagement in OAT. These formative data will help the candidate to establish a productive early career as a physician-scientist and advise development of an OAT-delivery strategy to mitigate infectious complications of injection opioid use. Through this award, Dr. Goodman-Meza will establish himself as an expert physician-scientist at the intersection of infectious disease and addiction, poised to make significant contributions to this important area of medicine.