Using Routine Care Electronic Medical Record Data and Artificial Intelligence to Develop a Passive Digital Marker to Predict Postoperative Delirium

项目摘要 术后谵妄是择期手术后最常见的并发症之一。谵妄是 与住院时间延长、功能下降、认知障碍、费用增加和 mortality.这份提案描述了一个职业发展计划，将把莫汉蒂医生变成一个病人- 一项面向研究者的研究，致力于改善每一位接受手术的美国老年人的围手术期大脑健康。 大手术Mohanty博士提出的项目将涉及合并超过35000名患者的数据， 在全州范围内的卫生系统中接受了大手术，电子健康记录（EHR）数据来自 印第安纳州病人护理网络（INPC），一个区域卫生信息交换所。使用此合并 数据库，候选人将开发和测试术后的被动预测模型（“数字标记”） 谵妄风险使用常规护理EHR数据，包括非结构化，自由文本笔记和机器学习 算法然后，这种“数字标记”将在试点随机临床试验中进行测试，为大规模的 一项疗效试验，将评估这种可扩展的“数字标记”对短期和长期认知能力的影响。 结果。 拟议的职业发展计划包括： 医学信息学的课程和结构化教学法，包括高级分析，人工 智能和临床决策支持;实施科学;通过进行体验式学习， 研究项目;支持性的研究环境。该环境包括一个 国际公认的NIH资助的谵妄研究小组，著名的印第安纳州大学谵妄研究中心， 老龄化研究，美国国立卫生研究院资助的印第安纳州阿尔茨海默病中心，和美国国立卫生研究院资助的印第安纳州临床和 翻译科学研究所（CTSI）。这个职业发展奖将保证保护的时间， 有必要推进候选人在围手术期脑健康的职业生涯。此外，该奖项将 为未来R 01疗效随机对照试验的数据收集提供关键支持。

PROJECT SUMMARY Postoperative delirium is among the most common complications following elective surgery. Delirium is associated with prolonged lengths of stay, functional decline, cognitive impairment, higher costs, and higher mortality. This proposal describes a career development plan that will transform Dr. Mohanty into a patient- oriented investigator focused on improving the perioperative brain health of every older American undergoing major surgery. Dr. Mohanty’s proposed project will involve merging the data of more than 35000 patients who underwent major surgery in a statewide health system with electronic health record (EHR) data from the Indiana Network for Patient Care (INPC), a Regional Health Information Exchange. Using this merged database, the candidate will develop and test a passive predictive model (“digital marker”) for postoperative delirium risk using routine care EHR data, including unstructured, free text notes, and a machine learning algorithm. This “digital marker” will then be tested in a pilot randomized clinical trial in preparation for a large efficacy trial which will evaluate the impact of this scalable “digital marker” on short and long-term cognitive outcomes. The proposed career development plan integrates: close mentoring from a multidisciplinary team of senior scientists; coursework and structured didactics in medical informatics, including advanced analytics, artificial intelligence, and clinical decision support; implementation science; experiential learning via the conduct of the proposed research project; and a supportive research environment. This environment includes an internationally recognized NIH-funded delirium study group, the distinguished Indiana University Center for Aging Research, the NIA-funded Indiana Alzheimer’s Disease Center, and the NIH-funded Indiana Clinical and Translational Sciences Institute (CTSI). This career development award will guarantee protected time that will be necessary to advance the candidate’s career in perioperative brain health. In addition, the award will provide critical support to collect data for a future R01 efficacy randomized controlled trial.