Postpartum Hemmorrhage and Anemia: Epidemiologic and Cost-Effectiveness Analyses

产后出血和贫血：流行病学和成本效益分析

• 批准号: 8442725
• 负责人: Alexander James Butwick
• 金额: $ 13.26万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-01-01 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8442725
• 关键词: Address; Admission activity; Adverse effects; Advocate; Affect; Anaphylaxis; Anemia; Anesthesiology; Anesthetics; California; Caring; Cessation of life; Clinical; Clinical Data; Clinical Informatics; Clinical Research; Cognitive; Cognitive deficits; Cohort Studies; Collaborations; Complication; Consensus; Cost Effectiveness Analysis; Costs and Benefits; Data; Databases; Decision Making; Decision Modeling; Demographic Factors; Development Plans; Discipline; Discipline of obstetrics; Early treatment; Education; Electronics; Epidemiology; Erythrocyte Transfusion; Fatigue; Future; Goals; Health; Health Maintenance Organizations; Health Services Research; Hemorrhage; Hospitalization; Hour; Hypersensitivity; Hysterectomy; Impairment; Incidence; Intensive Care; Interdisciplinary Study; Intravenous; Iron; Knowledge; Lead; Leadership; Link; Logistic Regressions; Maternal Health; Medical; Medicine; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Modeling; Morbidity - disease rate; Nested Case-Control Study; Oral; Outcome; Outcomes Research; Patients; Pediatric Hospitals; Perinatal; Perinatology; Pharmaceutical Preparations; Physicians; Policy Research; Population Study; Postoperative Period; Postpartum Hemorrhage; Postpartum Period; Postpartum Women; Pregnancy; Public Health; Qualifying; Quality of life; Regimen; Research; Research Personnel; Research Training; Resources; Risk; Risk Assessment; Risk Factors; Stratification; Techniques; Therapeutic; Training; Transfusion; Treatment Efficacy; Treatment Protocols; Universities; Woman; absorption; adverse outcome; base; career; career development; clinical epidemiology; computerized; cost; cost effective; cost effectiveness; effective therapy; gastrointestinal; improved; innovation; intrapartum; markov model; medical schools; mortality; multidisciplinary; programs; psychologic; public health relevance; screening; therapy design; trend

DESCRIPTION (provided by applicant): This is a revised application for a K23 award to support Dr. Alexander Butwick's proposed research and training focusing on clinically effective and cost-effective strategies for reducing hematologic-related maternal morbidities, specifically postpartum hemorrhage (PPH) and early postpartum anemia (EPA), in women undergoing cesarean delivery (CD). Severe PPH can cause major obstetric morbidity and is a leading cause of maternal death in the US; EPA is an underappreciated adverse outcome, which may lead to long-term deleterious psychological, physical, and cognitive effects among postpartum women. Currently, risk- stratification for severe PPH and EPA and therapeutic approaches for EPA lack consensus and are predominantly non-standardized. For women undergoing CD, innovative approaches are needed for: (1) preoperative risk stratification for PPH and, (2) postoperative screening and cost-effective treatment regimens for EPA. These approaches comprise the central aspects of the proposed research. In Aim 1, Dr. Butwick will perform a nested case-control study, using hospitalization data at Stanford University School of Medicine (SUSM), to determine predictors and develop prediction models for severe PPH in patients undergoing prelabor CD and intrapartum CD. In Aim 2, Dr. Butwick will assess the incidence of and risk factors for EPA in women post-CD using linked hospitalization databases from Kaiser Permanente Medical Care Program - Northern California (KPMCP-NC). In Aim 3, Dr. Butwick will perform a cost-effectiveness analysis to assess the costs, benefits, and harms of oral versus intravenous iron therapy for the treatment of EPA. The candidate is an obstetric anesthesiologist at SUSM with additional training in Clinical Epidemiology, and is therefore uniquely qualified to address these aims. Furthermore, Dr. Butwick is supported by a multidisciplinary and collaborative team with expertise in Clinical Epidemiology, Obstetrics, Perinatology, Health Services Research, and Anesthesiology. The candidate's proposal will benefit from the diverse strength of resources at SUSM (the Department of Health Research and Policy, the Stanford Center for Clinical Informatics) and at Division of Research, KPMCP-NC. To accomplish his research goals and prepare him for a career as an independent investigator, Dr. Butwick has created a multi-disciplinary career development plan incorporating: (1) graduate level didactic training in health outcomes research with mentoring in cost-effectiveness analyses and analytic approaches for medical decision-making; (2) mentoring in advanced epidemiologic techniques, integrating electronic health information and linked hospitalization databases; (3) targeted education in obstetrical and perinatal medicine; and (4) mentoring in leadership in interdisciplinary research in obstetric anesthesiology and perinatology. Successful completion of this research will form the basis for future R01 applications to validate the clinical effectivenes and cost-effectiveness of computerized predictive rules for severe PPH and to investigate individualized therapeutic strategies for EPA and other major peripartum morbidities.

描述（由申请人提供）：这是K23奖的修订申请，以支持Alexander Butwick博士提出的研究和培训，重点是临床有效和具有成本效益的策略，以减少剖腹产（CD）妇女的血液学相关产妇发病率，特别是产后出血（PPH）和产后早期贫血（EPA）。严重PPH可导致重大产科疾病，是美国孕产妇死亡的主要原因；EPA是一种未被充分认识的不良后果，它可能导致产后妇女长期有害的心理、生理和认知影响。目前，严重PPH和EPA的风险分层和EPA的治疗方法缺乏共识，主要是非标准化的。对于接受CD的妇女，需要创新的方法：(1)PPH的术前风险分层；(2)EPA的术后筛查和成本效益治疗方案。这些方法构成了本研究的核心内容。在第一个目标中，Butwick博士将使用斯坦福大学医学院（SUSM）的住院数据进行一项嵌套病例对照研究，以确定预测因素并开发产前和产时CD患者严重PPH的预测模型。在第二个目标中，Butwick博士将使用来自北加州Kaiser Permanente医疗保健计划（KPMCP-NC）的相关住院数据库，评估CD后妇女EPA的发生率和危险因素。在Aim 3中，Butwick博士将进行成本-效果分析，以评估口服与静脉注射铁治疗EPA的成本、收益和危害。该候选人是南马医科大学的产科麻醉师，接受过临床流行病学方面的额外培训，因此具有实现这些目标的独特资格。此外，Butwick博士还拥有临床流行病学、产科、围产期、卫生服务研究和麻醉学方面的多学科合作团队。候选人的提案将受益于SUSM（斯坦福临床信息学中心卫生研究与政策部）和KPMCP-NC研究部的各种资源优势。为了完成他的研究目标，并为他作为一名独立研究者的职业生涯做好准备，Butwick博士创建了一个多学科的职业发展计划，包括：(1)研究生水平的健康结果研究教学培训，指导成本效益分析和医疗决策的分析方法；(2)指导流行病学先进技术，整合电子卫生信息和住院数据库；(3)有针对性地开展产科和围产期医学教育；(4)指导领导产科麻醉学和围产儿跨学科研究。这项研究的成功完成将为未来的R01应用奠定基础，以验证严重PPH的计算机预测规则的临床效果和成本效益，并研究EPA和其他主要围产期发病率的个性化治疗策略。