Automated ascertainment of bleeding and target lesion revascularization after percutaneous coronary intervention (PCI) using electronic health record (EHR) data

使用电子健康记录 (EHR) 数据自动确定经皮冠状动脉介入治疗 (PCI) 后的出血和目标病变血运重建

• 批准号: 10371710
• 负责人: Karthik Murugiah
• 金额: $ 16.57万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-25 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10371710
• 关键词: Adoption; Algorithms; Award; Back; Blood Transfusion; Cardiac; Cardiac Catheterization Procedures; Cardiovascular system; Career Choice; Clinical; Clinical Data; Clinical Informatics; Clinical Trials; Computational Linguistics; Custom; Data; Data Set; Data Sources; Derivation procedure; Detection; Electronic Health Record; Event; Feedback; Generations; Goals; Health; Health Sciences; Health system; Healthcare Systems; Hemorrhage; Hospitalization; Hospitals; Hybrids; Image; Individual; Institution; Knowledge; Laboratories; Lesion; Manuals; Measurement; Medical Informatics; Mentors; Mentorship; Methods; Monitor; Morbidity - disease rate; Myocardial Ischemia; Natural Language Processing; Natural Language Processing pipeline; Observational Study; Outcomes Research; Patients; Performance; Positioning Attribute; Pragmatic clinical trial; Procedures; Process; Provider; Reporting; Research Personnel; Resources; Risk; Safety; Schedule; Signal Transduction; Site; Source; Standardization; Stents; Structure; Surveys; System; Techniques; Testing; Text; Time; Training; Work; adjudicate; automated algorithm; base; clinical outcome measures; comparative effectiveness study; comparative effectiveness trial; data lake; data registry; deep learning; disease registry; experience; health information technology; improved; information model; mortality; multidimensional data; open source; percutaneous coronary intervention; portability; predictive modeling; prospective; quality assurance; restenosis; risk prediction model; skills; stent thrombosis; structured data; supervised learning; support tools; tool; training opportunity; unstructured data

PROJECT SUMMARY Percutaneous coronary intervention (PCI) is the most common cardiac procedure with over 650,000 PCI performed annually in the U.S. Post-PCI complications which occur in a significant proportion of patients are associated with an increased risk of morbidity and mortality. Reliable ascertainment of post-PCI events is important for performance measurement, submission to disease registries, clinical trials, and for cardiac catheterization laboratory (CCL) safety monitoring. Claims based detection of PCI complications is inadequate. Assessing post-PCI events reliably requires an in-depth manual chart review, which incurs a significant provider and administrative burden. However, with advances in health information technology and nationwide adoption of electronic health record (EHR) systems, it possible to utilize EHR for the automatic derivation of clinical events. Dr. Murugiah proposes to create and validate automated algorithms which can be applied to EHR data to detect two important post-PCI events which are a common focus of clinical trials and quality improvement efforts – in-hospital bleeding and 1-year target lesion revascularization (TLR). Using EHR data at a large health system, Dr. Murugiah will develop a hybrid algorithm to detect major bleeding post-PCI by leveraging structured data fields such as laboratory values, as well as unstructured data such as imaging reports, cardiac catheterization reports, and progress notes incorporating Natural Language Processing (NLP) techniques (Aim 1). Similarly, using cardiac catheterization reports for patients undergoing repeat revascularization within 1 year, an algorithm will be developed to detect TLR (Aim 2). Both algorithms will be externally validated using EHR data from another large institution. The final algorithm will be implemented into a tool generating scheduled reports of bleeding and TLR, to be fed back to the quality assurance team for the CCL and to individual operators. Individual operators will be surveyed to obtain feedback about the algorithm, reporting process, and their perceived benefit. The final tools will be made open source (Aim 3). An automated algorithm for the detection of post-PCI events within EHR can reduce administrative burden, enable the generation of new knowledge from EHR based observational studies, and enable pragmatic clinical trials. Further, this project can serve as a proof of concept of the utility of hybrid tools leveraging both structured data and clinical text for surveillance and quality measurement. Dr. Murugiah has a career interest in studying and improving the treatment for ischemic heart disease using multidimensional datasets and EHR data to develop real time risk prediction models and decision support tools, and conduct EHR based comparative effectiveness studies and clinical trials. During the award period he will leverage the experience of his mentorship team which includes national experts in cardiovascular outcomes research, clinical informatics, and computational linguistics. He will also acquire formal training in clinical informatics by completing a Master of Health Science degree which will provide him the necessary platform to make the transition into an independent investigator.

项目摘要 经皮冠状动脉介入治疗（PCI）是最常见的心脏手术， 在美国，每年进行一次PCI术后并发症， 与发病率和死亡率风险增加相关。PCI后事件的可靠确定是 对于性能测量、提交疾病登记、临床试验和心脏 导管室（CCL）安全监测。基于声明的PCI并发症检测不足。 可靠地评估PCI后事件需要深入的手动图表审查，这会导致严重的 供应商和行政负担。然而，随着卫生信息技术的进步和全国范围内的 采用电子健康记录（EHR）系统，可以利用EHR自动导出 临床事件。Murugiah博士建议创建和验证自动化算法，可应用于 EHR数据用于检测两种重要的PCI后事件，这是临床试验和质量的共同焦点 改善措施-院内出血和1年靶病变血运重建（TLR）。使用EHR数据， Murugiah博士将开发一种混合算法来检测PCI术后的大出血， 利用结构化数据字段（如实验室值）以及非结构化数据（如成像 纳入自然语言处理（NLP）的报告、心导管插入术报告和进度记录 技术（目标1）。同样，使用心脏导管检查报告， 如果在1年内完成血运重建，将开发一种算法来检测TLR（目标2）。这两种算法都将 使用来自另一家大型机构的EHR数据进行外部验证。最终算法将被实现为 生成出血和TLR计划报告的工具，反馈给质量保证团队， CCL和个人操作员。将对各个操作员进行调查，以获得有关算法的反馈， 报告过程及其预期效益。最终的工具将开放源代码（目标3）。自动 EHR中PCI后事件检测算法可以减少管理负担， 从基于EHR的观察性研究中产生新的知识，并实现实用的临床试验。 此外，该项目可以作为利用结构化数据的混合工具的实用性的概念证明 和临床文本进行监督和质量测量。Murugiah博士的职业兴趣是学习， 使用多维数据集和EHR数据改进缺血性心脏病的治疗， 真实的时间风险预测模型和决策支持工具，并进行基于EHR的比较有效性 研究和临床试验。在奖励期间，他将利用他的导师团队的经验 包括心血管结局研究、临床信息学和计算医学领域的国家专家。 语言学他还将通过完成健康科学硕士学位获得临床信息学的正式培训 学位，这将为他提供必要的平台，使过渡到一个独立的调查。