International comparisons of 'big' health record data: application to cardiovascular diseases

心血管疾病（CVD）仍然是英国和世界范围内的主要死亡原因。随着药物治疗和血运重建干预的医学进步，急性住院治疗期缩短，心血管疾病的护理逐渐转移到基层护理和社区服务。国际比较可以提供证据的表现，卫生系统在心血管疾病护理国家之间，从而促进学习更好的表现系统。近期的重大挑战之一是利用初级和二级保健产生的国际结构化编码数据，填补将预防和治疗的科学证据投入临床实践以改善人口健康的差距。虽然英国医疗保健数据的质量和全面性在世界上是例外的，但英国健康记录在国际研究环境中使用的情况非常少。一个核心瓶颈是了解哪些电子健康记录（EHR）源可用于研究，以及它们的优点和缺点。目前还没有作出协调一致的努力，使这些数据源“可共享"，可供国际研究界使用。即使是最简单的问题（例如，哪些国家有初级保健数据可供研究，哪些国家可以提供有关吸烟、血压和胆固醇的有意义的数据）没有现成的答案。在MRC人口健康科学家奖学金的支持下，与法尔研究所密切合作，我将扩大在关联人群健康记录方面的国际合作，以调查心脏护理方面的重要研究问题，并解决健康信息学领域的一些障碍。我将通过解决两个相互交织的目标来实现这一目标：（i）临床研究：解决两个或两个以上国家心血管疾病预防和进展的研究问题，这些问题只能通过电子健康记录数据来解决。(ii)信息学方法：通过与法尔研究所的健康信息学专家密切合作，促进发现和记录与具有不同医疗保健系统的国家的心血管疾病研究相关的当代EHR数据源。临床研究的目的首先是比较两个或两个以上国家的主要新指南建议的依从性与大范围CVD减少的相关程度。更多国家。第二，比较两个或两个以上国家急性心肌梗死后心血管疾病（如心力衰竭）的短期和长期发病率。(ii)信息学方法的目标将首先建立一个跨学科的国际研究者和资源网络，寻求使EHR数据源可共享和可共享的心血管研究。第二，通过法尔研究所和卫生信息学网络，促进创建一个国际可搜索的电子健康记录数据元数据目录。潜在的应用和好处通过专注于CVD，研究结果有望提供有效的卫生系统和护理策略的见解，以促进人口的健康和福祉。这项研究可以通过首先提供对各国预防和治疗护理的质量和结果后果的独特理解来促进知识。其次，与实质性的临床问题紧密交织在一起，我将能够通过使各国的复杂数据源更加“可解释”来促进方法的知识，并提供所需的上下文和元数据信息，以便使用这些数据源扩展可复制的研究。这项研究将有助于我们对国际卫生信息学研究的研究合作，研究协调和信息治理的认识。

Cardiovascular diseases (CVD) remain the leading cause of death in the UK and worldwide. With medical advancement in drug treatment and revascularization intervention, the acute hospital treatment phase shortens and the care for CVD has gradually shifted to primary care and community services. International comparisons can provide evidence of performance of health system in CVD care between countries, and thus facilitate learning from better performing systems. One of the near-term grand challenges is to exploit international structured coded data arising from primary and secondary care to address the gap of putting scientific evidence on prevention and treatment into clinical practice to improve population health. While the quality and comprehensiveness of UK healthcare data is exceptional in world, there are remarkably few instances of UK health records being used in international research contexts. A central bottleneck is knowing what electronic health records (EHR) sources are available for research, and their strengths and weakness. There has been no concerted effort to make such data sources 'discoverable,' shareable or accessible to the international research community. Even the most simple questions (e.g. which countries have primary care data available for research, and which of these can provide meaningful data on smoking, blood pressure and cholesterol) do not have readily accessible answers.With the support from the MRC Population Health Scientist Fellowship, in close collaboration with the Farr institute, I will expand international collaboration on linked population health records to investigate important research questions on cardiac care, and address some of the barriers in the field of health informatics. I will do this by addressing two interwoven aims: (i) Clinical research: to address research questions in the prevention and progression of cardiovascular diseases across two or more countries, which can only be tackled using electronic health record data. (ii) Informatics methods: To facilitate the discovery and documentation of contemporary EHR data sources relevant to cardiovascular disease research in countries with diverse healthcare systems by working in close collaboration with health informatics experts across the Farr Institute.OBJECTIVES (i) Clinical research objectives will be first to compare the extent to which adherence to major new guideline recommendations might be associated with reduction in a wide range of CVD in two or more countries. Second, to compare the incidence of CVD, such as heart failure in the short and long term after acute myocardial infarction between two or more countries. (ii) Informatics method objectives will be first to build an inter-disciplinary, international network of investigators and resources seeking to make EHR data sources discoverable and sharable for cardiovascular research. Second, to facilitate the creation of an international searchable meta-data catalogue of EHR data from different health care settings through the Farr Institute and the Health Informatics Network. Potential applications and benefitsBy focused on CVD, research results are expected to provide insights on effective health system and care strategies to contribute to the health and wellness of the population. The research may contribute to knowledge by firstly providing the unique understanding the quality and outcome consequences of preventive and treatment care across countries. Secondly, and tightly interwoven with the substantive clinical questions, I will be able to contribute to the knowledge of methods by making complex data sources across countries more 'discoverable', and provide the contextual and metadata information required in order to scale replicable research using these data sources. The research will contribute to our knowledge on research collaboration, study coordination and information governance for international health informatics studies.