Predicting Exacerbations of Asthma in Real-World Patients with Low Medical Utilization (PEARL)

预测现实世界中医疗利用率低的患者的哮喘恶化 (PEARL)

基本信息

批准号：
10585179
负责人：
Wansu Chen
金额：
$ 77.38万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-02-21 至 2027-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10585179
关键词：
Acute Adrenal Cortex Hormones Affect Age Air Air Pollutants American Anxiety Asthma Belief California Caring Categories Chest Chronic Classification Clinical Complex Comprehensive Health Care Consultations Coughing Crime Data Data Sources Disease Management Economic Burden Electronic Health Record Emergency Situation Ethnic Population Etiology Frequencies Future Guidelines Health Surveys Heterogeneity Impairment Inflammatory Integrated Health Care Systems Intervention Joints Knowledge Machine Learning Measures Medical Medical center Medicine Mental Depression Methods Modeling Neighborhoods Oral Patients Pharmaceutical Preparations Phenotype Physicians Population Prevalence Productivity Prospective cohort Provider Publishing Pulmonary function tests Quality of Care Reporting Research Retrospective cohort study Risk Risk Assessment Risk Factors Severities Shortness of Breath Specialist Surveys Symptoms Terminology Time Translations Wheezing Work asthma exacerbation asthma inhaler asthmatic patient burden of illness community-level factor deep learning ethnic diversity evidence base health care service health care service organization health plan high dimensionality high risk high risk population improved individual patient insight model development multi-ethnic patient stratification personalized approach personalized care personalized management personalized risk prediction predictive modeling predictive tools prospective pulmonary function racial diversity racial population risk prediction risk prediction model sex social health determinants treatment planning violent crime

项目摘要

PROJECT SUMMARY Asthma is a chronic inflammatory condition that affects > 20 million Americans. The prevalence of asthma has been increasing since the early 1980s in all age, sex, and racial groups. There is no universal method for de- termining asthma severity. The terminology and the definition used in various asthma guidelines have evolved over time. Most commonly, asthma severity is determined by clinical parameters such as medica- tion use, presence and/or frequency of asthma symptoms, number of asthma exacerbations (which are acute or subacute episodes of progressively worsening shortness of breath, cough, wheezing, and chest tight- ness or some combination of these symptoms), and/or the results of lung function tests. Patients with persis- tent asthma are at elevated risk for exacerbations (attack) and often have decreased lung function. Yet the bur- den of intermittent asthma is also significant: It affects 50-75% of all asthma patients and represents 30-40% of total asthma exacerbations requiring emergency consultation. Risk factors for asthma exacerbations have been studied in patients with persistent asthma. However, little is known about risk factors in patients with in- termittent asthma, nor have risk prediction models been reported. A focused study on risk factor identification and future risk prediction will provide valuable insights into the etiology of asthma exacerbations in intermittent asthma patients and facilitate a personalized approach in the management of the disease. Without a clear un- derstanding of the risk of asthma exacerbation for each individual patient with intermittent asthma, we will not be able to optimally define the most appropriate intervention strategies to reduce the burden of the disease in this group of patients. To operationalize the clinical definition of intermittent asthma, we will focus on a pheno- typic group of low utilizers referred to in guidelines as intermittent asthma. We propose to identify potential risk factors for asthma exacerbation in low utilizers using high-dimensional and longitudinal KPSC EHR and exter- nal data sources (including air quality measures, social determinants of health and violent crime), subsequently develop and validate risk prediction models to stratify patients into low- and high-risk groups, and externally validate the risk prediction model using EHR data of another large health care organization. We also propose to establish a prospective cohort of low utilizers and collect patient-reported information (PRI) via a survey. The PRI will help characterize the patients of low utilizers in terms of asthma symptoms, activities, impairment and risk assessment, work productivity, beliefs about medicines and anxiety/depression scales. We will develop and internally validate a risk prediction model based on both EHR and PRI data. The proposed models will al- low physicians to provide personalized care (e.g., develop or adjust treatment plans, provide personal asthma action plans accordingly, and refer patients to asthma specialists when necessary) and thus improve the qual- ity of care and reduce asthma burden. Our proposal to examine heterogeneity across different racial/ethnic groups has the potential to inform practice for more accurate asthma risk assessment.

项目概要哮喘是一种慢性炎症，影响超过 2000 万美国人。哮喘的患病率已自 20 世纪 80 年代初以来，所有年龄、性别和种族群体的患病率都在增加。没有通用的方法来解终止哮喘严重程度。各种哮喘指南中使用的术语和定义随着时间的推移而演变。最常见的是，哮喘的严重程度是由临床参数决定的，例如药物哮喘症状的存在和/或频率、哮喘发作的次数（包括急性或亚急性发作，逐渐恶化的气短、咳嗽、喘息和胸闷或这些症状的某种组合）和/或肺功能测试的结果。持续存在的患者帐篷性哮喘恶化（发作）的风险较高，并且肺功能常常下降。然而，间歇性哮喘的发病率也很重要：它影响所有哮喘患者的 50-75%，占所有哮喘患者的 30-40% 哮喘总恶化需要紧急会诊。哮喘发作的危险因素有在持续性哮喘患者中进行了研究。然而，人们对患有内科疾病的患者的危险因素知之甚少。间歇性哮喘，也没有风险预测模型的报道。危险因素识别的重点研究未来的风险预测将为间歇性哮喘发作的病因学提供有价值的见解哮喘患者，并促进疾病管理的个性化方法。没有明确的un- 了解每个间歇性哮喘患者的哮喘恶化风险，我们不会能够最佳地确定最合适的干预策略，以减轻疾病负担这组患者。为了实施间歇性哮喘的临床定义，我们将重点关注以下表型：典型的低利用率群体在指南中被称为间歇性哮喘。我们建议识别潜在风险使用高维和纵向 KPSC EHR 和外部分析来确定低利用率者哮喘恶化的因素最终数据源（包括空气质量测量、健康的社会决定因素和暴力犯罪），随后开发和验证风险预测模型，将患者分为低风险组和高风险组，并在外部使用另一个大型医疗保健组织的 EHR 数据验证风险预测模型。我们还建议建立低利用率人群的前瞻性队列，并通过调查收集患者报告信息 (PRI)。这 PRI 将帮助描述低利用率患者的哮喘症状、活动、损伤和风险评估、工作效率、对药物的信念以及焦虑/抑郁量表。我们将开发并在内部验证基于 EHR 和 PRI 数据的风险预测模型。所提出的模型将全部医生提供个性化护理的能力较低（例如，制定或调整治疗计划、提供个人哮喘治疗相应的行动计划，并在必要时将患者转介给哮喘专家），从而提高质量护理质量并减少哮喘负担。我们建议检查不同种族/民族的异质性团体有可能为实践提供信息，以进行更准确的哮喘风险评估。