Epidemiology and clinical outcomes of diabetic macular edema

大约25%的退伍军人（估计。8.92 2013财年）登记参加退伍军人健康护理 糖尿病患者中，糖尿病性黄斑水肿（diabetic macular edema，DME）是导致视力下降的主要原因 全世界成年糖尿病患者的死亡率。虽然糖尿病视网膜病变已经得到了很好的研究， 对DME的负荷知之甚少。事实上，只有两项全国流行率研究， 已经进行了关于2型糖尿病患者DME发病率的全国性研究。同样，许多 DR的危险因素已被描述，但没有大型研究建立DME的预测因子。 除了医疗保险索赔数据库，VHA国家患者护理数据库（NPCD）还包含 用于病人护理的几个方面的标准化管理数据，包括诊断，程序， 药物、实验室检查结果、生命体征、临床文本记录和死亡率。因为退伍军人管理局使用远程视网膜 筛查作为所有糖尿病患者的常规临床护理，这些结果包括在NPCD中， NPCD是研究DME流行病学和危险因素的理想来源。 本研究旨在确定糖尿病性黄斑水肿的负担，建立危险因素， 在先前提取的198万名退伍军人的数据集中检查治疗结果， 自2004年以来至少进行一次糖尿病视网膜病变筛查。目前，宝贵的眼科数据被编码在 计算机化患者记录系统（CPRS）中的非结构化临床就诊记录， 存在自动提取方法来捕获这些数据元素。自动提取方法， 将创建并验证自然语言处理以解锁关键眼科变量。这些文本 提取方法将适用于从患者的记录中提取眼科数据， DME以及任何眼科临床记录。这将使未来的大规模研究眼科 使用NPCD，并立即对整个研究社区有价值。 候选人，博士亚伦李，医学博士MSCI，是一个眼科医生与亚专业培训视网膜 拥有计算机科学和流行病学背景的外科医生。他的职业目标是成为一名 独立临床科学家利用大规模电子病历研究糖尿病眼病 提取的数据。虽然他拥有基本技能，但他寻求获得高级统计学方面的培训， 自然语言处理，以解锁在非结构化临床诊疗记录中捕获的数据。他 在主要导师Edward Boyko博士（医学博士、公共卫生硕士）的领导下组建了一支杰出的导师团队。这 导师团队包括临床流行病学、健康信息学、眼科学和 自然语言处理这个K23将为李博士提供结构化的课程，指导和应用 学习需要获得新的研究技能。他将利用当地的关键资源， 华盛顿大学和弗吉尼亚州西雅图流行病学研究和信息中心的研究。

Approximately 25% of the millions of veterans (est. 8.92 million FY 2013) enrolled for care in Veterans Health Administration (VHA) have diabetes mellitus, and diabetic macular edema (DME) is the leading cause of vision loss in the adult diabetic population world-wide. Although diabetic retinopathy has been well-studied, comparatively little is known about the burden of DME. In fact, only two national prevalence studies and no national study on the incidence of DME in persons with type 2 diabetes have been conducted. Similarly many risk factors have been characterized for DR, but no large studies have established predictors for DME. Beyond the Medicare claims database, the VHA National Patient Care Database (NPCD) contains standardized administrative data for several aspects of patient care including diagnoses, procedures, medications, lab test results, vital signs, clinical text notes, and mortality. Because the VA uses teleretinal screening as routine clinical care for all patients with diabetes with these results included in the NPCD, the NPCD is an ideal source for studying the epidemiology of and risk factors for DME. This study proposes to determine the burden of diabetic macular edema, establish risk factors, and examine treatment outcomes in a previously extracted dataset on 1.98 million veterans who have undergone diabetic retinopathy screening at least once since 2004. Currently invaluable ophthalmic data are encoded in unstructured clinical encounter notes in the Computerized Patient Record System (CPRS), and no validated automated extraction method exists to capture these data elements. An automated extraction method using natural language processing will be created and validated to unlock key ophthalmic variables. These text extraction methods will be applicable to extracting ophthalmology data from not only notes of patients with DME but also any ophthalmology clinical note. This will enable future large scale studies in ophthalmology using NPCD and be immediately valuable to the research community at large. The candidate, Dr. Aaron Lee, MD MSCI, is an ophthalmologist with subspecialty training in retina surgery with a strong background in computer science and epidemiology. His career goal is to become an independent clinician scientist studying diabetic eye disease with large-scale electronic medical record extracted data. While he possesses the foundational skills, he seeks to gain training in advanced statistics and natural language processing to unlock the data captured in unstructured clinical encounter notes. He has assembled an outstanding mentorship team under the primary mentor, Dr. Edward Boyko, MD MPH. This mentorship team includes renowned experts in clinical epidemiology, health informatics, ophthalmology, and natural language processing. This K23 will provide Dr. Lee the structured coursework, mentorship, and applied learning needed to acquire new research skills. He will leverage key local resources to carry out the proposed research at the University of Washington and the VA Seattle Epidemiologic Research and Information Center.