WASHINGTON UNIVERSITY COMPARATIVE EFFECTIVENESS ADMINISTRATIVE DATA REPOSITORY

描述（由申请人提供）：我们建议扩展和增强管理数据存储库，以促进复杂患者的比较有效性研究（CER）。数据库是由WU临床和转化科学研究所的启动资金开发的。启动资金用于存储和维护多个大型管理数据集，并为整个大学的卫生服务和成果研究提供数据管理和分析专业知识。这些数据的规模和复杂性为研究用于治疗患有多种基础疾病的患者的护理，程序和治疗过程提供了充足的机会。要求提供赠款，以进一步发展服务器基础设施，有效储存和分析大型行政数据文件，并购买更多的行政数据，扩大现有信息的范围。我们将开发一个标准编程代码库，以管理多个大型和复杂的数据文件，并将诊断和程序代码转换为有临床意义的分类模式进行分析。编程代码库的开发将通过修改现有代码而不是由个别研究者重新创建新代码来创造规模经济，从而使未来的研究者能够更有效地利用其资金进行创新CER。我们将为CER提供道德和安全使用管理数据的教育，并制定政策以确保遵守联邦和机构数据使用协议。为了证明该管理数据存储库在复杂患者中的CER能力，我们将确定所有患者以及糖尿病和肾衰竭患者亚组在初次植入植入式心脏器械后和器械翻修/置换后的器械相关感染发生率。我们将评估这些并发症对所有患者死亡率的影响，以及糖尿病和肾衰竭患者与诊断和器械取出时间的关系。我们还将确定复发性感染的发生率作为取出受感染器械后重新植入时间的函数。 公共卫生相关性：该基础设施奖的资金将用于扩大行政数据存储库，增加数据服务器的大小和计算能力，获得更多的数据文件用于研究，并开发教育材料和程序。这些改进将有助于使用大型复杂数据文件进行复杂患者的比较有效性研究。

DESCRIPTION (provided by applicant): We propose to expand and enhance an administrative data repository to facilitate comparative effectiveness research (CER) in complex patients. The data repository was developed with start-up funds from the WU Institute of Clinical and Translational Sciences. The start-up funds were provided to store and maintain multiple large administrative datasets and provide data management and analytic expertise for health services and outcomes research throughout the University. The size and complexity of these data provide ample opportunities to investigate processes of care, procedures, and therapies used to treat patients with multiple underlying illnesses. Grant funds are requested to further develop the server infrastructure for efficient storage and analysis of the large administrative data files and to purchase additional administrative data to extend the breadth of available information. We will develop a library of standard programming code to manage the multiple large and complex data files and to translate diagnosis and procedure codes into clinically meaningful classification schemas for analysis. Development of the programming code library will create an economy of scale through modification of existing code, rather than recreation of new code by individual investigators, thus allowing future investigators to more efficiently use their funds to perform innovative CER. We will provide education in the ethnical and secure use of administrative data for CER and develop policies to ensure compliance with federal and institutional data use agreements. To demonstrate the capacity of this administrative data repository for CER in the complex patient, we will determine the incidence of device associated infection after initial placement of an implantable cardiac device and after device revision/replacements in all patients, and in subsets of patients with diabetes and renal failure. We will assess the impact of these complications on mortality in all patients, and patients with diabetes and renal failure, in relation to time of diagnosis and device removal. We will also determine the incidence of recurrent infections as a function of time to re-implantation after removal of an infected device. PUBLIC HEALTH RELEVANCE: Funds from this infrastructure award will be used to expand an administrative data repository, by increasing the data server size and computing capacity, obtaining additional data files for research, and developing educational materials and programs. These enhancements will facilitate use of the large complex data files for comparative effectiveness research in complex patients.