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: 9198042
• 负责人: Alexander James Butwick
• 金额: $ 16.82万
• 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 2018-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9198042
• 关键词: Address; Admission activity; Adverse effects; Advocate; Affect; Anaphylaxis; Anemia; Anesthesiology; Anesthetics; California; Caring; Cesarean section; Cessation of life; Clinical; Clinical Data; Clinical Informatics; Clinical Research; Cognitive; Cognitive deficits; Collaborations; Complication; Consensus; Cost Analysis; Cost Effectiveness Analysis; Costs and Benefits; Data; Databases; Decision Making; Decision Modeling; Demographic Factors; Development Plans; Discipline; Discipline of obstetrics; Early treatment; Education; Epidemiologic Methods; 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; 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; Policies; Postoperative Period; Postpartum Hemorrhage; Postpartum Period; Postpartum Women; Pregnancy; Public Health; Quality of life; Regimen; Research; Research Personnel; Research Training; Resources; Retrospective cohort study; Risk Assessment; Risk Factors; Risk stratification; Techniques; Therapeutic; Training; Transfusion; Treatment Efficacy; Treatment Protocols; Universities; Woman; absorption; adverse outcome; base; career; career development; clinical epidemiology; clinical predictors; computerized; cost; cost effective; cost effectiveness; ferryl iron; gastrointestinal; improved; innovation; intrapartum; markov model; maternal morbidity; medical schools; mortality; multidisciplinary; perinatal medicine; programs; psychologic; public health relevance; screening; study population; 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 奖项的修订申请，旨在支持 Alexander Butwick 博士提出的研究和培训，重点关注临床有效且具有成本效益的策略，以减少接受剖腹产 (CD) 的妇女中与血液学相关的孕产妇发病率，特别是产后出血 (PPH) 和产后早期贫血 (EPA)。严重的 PPH 可导致严重的产科发病率，并且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，它可能对产后妇女造成长期有害的心理、身体和认知影响。目前，严重 PPH 和 EPA 的风险分层以及 EPA 的治疗方法缺乏共识，而且主要是非标准化的。对于接受 CD 的女性，需要创新方法：(1) PPH 术前风险分层，(2) EPA 术后筛查和经济有效的治疗方案。这些方法构成了拟议研究的核心方面。在目标 1 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巢式病例对照研究，以确定接受产前 CD 和产时 CD 的患者中严重 PPH 的预测因素并开发预测模型。在目标 2 中，Butwick 博士将使用北加州 Kaiser Permanente 医疗护理计划 (KPMCP-NC) 的链接住院数据库来评估 CD 后女性 EPA 的发病率和危险因素。在目标 3 中，Butwick 博士将进行成本效益分析，以评估口服铁剂疗法与静脉铁剂疗法治疗 EPA 的成本、益处和危害。该候选人是 SUSM 的产科麻醉师，接受过临床流行病学方面的额外培训，因此具有独特的资格来实现这些目标。此外，Butwick 博士得到了多学科协作团队的支持，该团队拥有临床流行病学、产科、围产期学、卫生服务研究和麻醉学方面的专业知识。候选人的提案将受益于 SUSM（健康研究与政策部、斯坦福临床信息学中心）和 KPMCP-NC 研究部的多元化资源优势。为了实现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，布特威克博士制定了一个多学科职业发展计划，其中包括：（1）健康结果研究的研究生水平教学培训，以及成本效益分析和医疗决策分析方法的指导； (2) 指导先进的流行病学技术，整合电子健康信息和链接的住院数据库； （三）有针对性的产科和围产期医学教育； (4) 指导产科麻醉学和围产期跨学科研究的领导力。这项研究的成功完成将为未来 R01 应用奠定基础，以验证严重 PPH 的计算机预测规则的临床有效性和成本效益，并研究 EPA 和其他主要围产期疾病的个体化治疗策略。