Career Development in Outcomes Assessment in Congenital Heart Surgery

描述（由申请人提供）：这份职业发展计划将为Sara Pasquali博士提供一个结构化的环境和专家指导，使她能够发展成为一名独立的儿科心血管结局研究研究者。先天性心脏缺陷很常见，是儿童发病和死亡的主要原因。虽然手术是治疗管理的基石，但关于先天性心脏手术患者结果评估的最佳策略的数据有限，指导最佳护理的证据也有限。管理数据集通常用于评估结果和比较儿科心脏中心的质量。然而，在行政资料中，病例确定、风险分层和结果评估的准确性尚不清楚。Pasquali博士将采用一种新颖的方法来评估在先天性心脏手术患者的结果和质量评估中行政和临床数据库的使用情况，以解决这些知识差距。这将涉及连接一个大型临床（胸外科学会先天性心脏手术数据库；STS-CHS）和行政（儿科健康信息系统数据库；PHIS）数据库，以临床数据库为金标准，比较这两个数据集中的病例确定和术后结果评估。这些数据，连同我们小组先前开发的经验风险分层方法，将用于开发和验证基于证据的算法，以便在未来的分析中使用准确的病例确定和风险分层。除了这些先进的研究技能外，Pasquali博士还将完成杜克大学临床研究培训计划中流行病学和生物静力学的正式培训，以获得硕士学位。她还将完成领导能力和科学写作方面的高级培训。这些职业发展活动将由一个具有成功开展心血管结果研究历史的多学科指导团队提供支持。指导小组在临床和行政数据集的分析和联系方面拥有丰富的经验，最近获得了NHLBI ARRA挑战补助金，用于使用链接的STS-CHS和公共卫生信息系统数据库进行比较有效性研究，该数据库也将用于该拟议项目。项目导师Eric Peterson博士是国际知名的心血管预后研究专家。其他小组成员将提供多中心儿科研究（Li）、结果分析（O'Brien, DeLong）以及STS-CHS （M Jacobs, J Jacobs）和公共卫生信息系统（Hall）数据的链接和分析方面的专业知识。该项目将在世界上最大的学术研究机构杜克临床研究所进行。Pasquali博士的长期目标是成为儿科心血管结果评估方面的专家，其总体目标是确定最佳实践并提高这一患者群体的护理质量。在优秀导师团队的指导下完成这份职业发展建议后，她将获得额外的正式培训和实现这些目标所需的高级研究技能。

DESCRIPTION (provided by applicant): This Career Development proposal will provide a structured environment with expert mentorship that will allow Dr. Sara Pasquali to develop into an independent investigator in pediatric cardiovascular outcomes research. Congenital heart defects are common, and a leading cause of morbidity and mortality in children. Although surgery is the cornerstone of therapeutic management, there are limited data regarding optimal strategies for outcomes assessment in patients undergoing congenital heart surgery, and limited evidence to guide optimal care. Administrative datasets are often utilized to evaluate outcomes and compare quality at pediatric heart centers. However, accuracy of case ascertainment, risk stratification, and outcomes assessment in administrative data is unknown. Dr. Pasquali will utilize a novel methodology to evaluate the use of administrative vs. clinical databases in outcomes and quality assessment for patients undergoing congenital heart surgery to address these knowledge gaps. This will involve linking a large clinical (Society of Thoracic Surgeons Congenital Heart Surgery Database; STS-CHS) and administrative (Pediatric Health Information Systems Database; PHIS) database to compare case ascertainment and post-operative outcomes assessment in these two datasets, using the clinical database as the gold standard. These data, along with empiric risk stratification methodology previously developed by our group, will be used to develop and validate an evidence-based algorithm for accurate case ascertainment and risk stratification for use in future analyses. In addition to these advanced research skills, Dr. Pasquali will complete formal training in epidemiology and biostatics in the Duke Clinical Research Training Program toward a Masters degree. She will also complete advanced training in leadership and scientific writing. These career development activities will be supported by a multidisciplinary mentorship team with a successful history of conducting cardiovascular outcomes research. The mentoring team has extensive experience in the analysis and linkage of clinical and administrative datasets, and was recently awarded an NHLBI ARRA Challenge Grant to conduct comparative effectiveness research using the linked STS-CHS and PHIS Databases which will also be used for this proposed project. Dr. Eric Peterson, project mentor, is an internationally renowned expert in cardiovascular outcomes research. Other team members will provide expertise in multicenter pediatric research (Li), outcomes analysis (O'Brien, DeLong), and linking and analysis of STS-CHS (M Jacobs, J Jacobs) and PHIS (Hall) data. The project will be conducted at the Duke Clinical Research Institute, the world's largest academic research organization. Dr. Pasquali's long-term goal is to become an expert in pediatric cardiovascular outcomes assessment, with an overall aim of defining best practices and improving quality of care in this patient population. Upon completion of this Career Development proposal under the guidance of an exceptional team of mentors, she will have the additional formal training and advanced research skills necessary to achieve these goals. PUBLIC HEALTH RELEVANCE: Relevance Congenital heart defects are the most common birth defects, and a leading cause of morbidity and mortality in children. However, evidence to guide optimal care in this population is limited. This proposal will utilize a novel approach to link a large clinical and administrative dataset in order to evaluate optimal strategies for outcomes assessment in patients undergoing congenital heart surgery.