Determinants of Achieving Target Serum Urate in Gout & Safety of Gout Treatments

实现痛风目标血清尿酸盐的决定因素

• 批准号: 9132599
• 负责人: jasvindar singh
• 金额: $ 31.78万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至 2017-09-19
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9132599
• 关键词: Accounting; Acute; Address; Adult; Adverse event; Affect; African American; Age; Algorithms; Allopurinol; Biopsy; Calcium Channel Blockers; Caring; Chronic Kidney Failure; Clinic; Clinical; Code; Colchicine; Comorbidity; Complete Blood Count; Creatinine; Cyclosporine; Data; Data Set; Databases; Decision Making; Diagnostic; Diagnostic tests; Disease; Dose; Drug Kinetics; Effectiveness; Electromyography; Electronic Health Record; Epidemiology; Ethnic Origin; Flare; Frequencies; Goals; Gout; Guidelines; Health; Health Care Costs; Health system; Healthcare; Heart Diseases; Hypersensitivity; ICD-9; Inflammatory Arthritis; Informatics; Inpatients; Integrated Health Care Systems; Intervention; Knowledge; Laboratories; Lead; Location; Macrolides; Maintenance; Manuals; Medical Care Costs; Medical center; Methodology; Methods; Modification; Morbidity - disease rate; Muscle; Natural Language Processing; Nerve; Outcome; Outpatients; Participant; Patient-Focused Outcomes; Patients; Pattern; Pharmaceutical Preparations; Pharmacy facility; Phosphotransferases; Physicians; Population; Prevalence; Provider; Quality of life; Race; Risk; Risk Factors; Rural; Safety; Sampling; Serum; Syndrome; Synovial Fluid; System; Text; Translational Research; Urate; Validation; Veterans; base; care systems; cohort; compliance behavior; cost; design; high risk; improved; innovation; men; modifiable risk; mortality; nerve conduction study; older patient; research study; residence; rheumatologist; treatment center

Our long-term goal is to improve health outcomes in patients with gout, the most common inflammatory arthritis in adult men. Inability to achieve a target serum urate of <6 mg/dl is common in gout patients undergoing treatment with urate-lowering therapy, which is associated with more acute gout flares, higher societal costs, and diminished quality of life. High-quality national studies of gout have been limited by the lack of availability of serum urate results in large national databases and use of only ICD-9 codes to identify gout cohorts, and when used alone ICD-9 codes may be inaccurate. Innovations in Veterans Affairs (VA) informatics including Natural language processing (NLP) algorithms, ability to obtain serum urate in national VA databases and to merge inpatient, outpatient and pharmacy databases allow conduct of high quality studies in gout. Data regarding patient, physician and healthcare factors influencing the ability to achieve target serum urate <6 mg/dl are lacking. Major adverse events (AEs) such as allopurinol hypersensitivity syndrome (AHS) and colchicine-associated neuromyopathy and hematologic AEs are associated with significant morbidity and mortality and have not been studied with well-designed, adequately-powered studies The main objective of this proposal is to study the effectiveness an safety of gout medications using national VA databases. Our project is innovative in using NLP algorithm to develop a large valid national cohort of gout patients, extracting serum urate levels and validating and studying AEs in a large gout cohort. Specific Aim 1: To identify key patient, provider, and health system factors associated with achieving and maintaining serum urate below 6 mg/dl ("target") in gout patients taking allopurinol. Specific Aim 2: To characterize the epidemiology and risk factors for major adverse events (AEs) associated with the use of allopurinol and colchicine for treatment of gout. We will use natural language processing (NLP) algorithm that incorporates the rich information from national VA EHR (text field data from clinic notes) and nationally available laboratory results (serum urate, synovial fluid result) in addition to lCD-9 codes to more accurately identify gout patients. With a similar approach, we will identify a validated cohort of gout patients with major AEs. We will examine association of key (patient, physician, healthcare) factors with ability to achieve target serum urate and with risk of major AEs.

我们的长期目标是改善痛风患者的健康状况，这是最常见的炎症 成年男性关节炎。痛风患者无法实现<6 mg/dl的靶血清尿酸盐是常见的 接受降低尿酸盐治疗的治疗，这与更多的急性痛风相关，更高 社会成本和生活质量下降。高质量的痛风国家研究受到了 缺乏血清尿酸盐的可用性会导致大型国家数据库，仅使用ICD-9代码来识别 痛风队列，单独使用时，ICD-9代码可能不准确。退伍军人事务的创新（VA） 包括自然语言处理（NLP）算法在内的信息学，在国家中获得血清的能力 VA数据库并合并住院，门诊和药房数据库允许进行高质量的行为 痛风的研究。有关患者，医师和医疗保健因素的数据，影响了实现能力 缺乏靶血清尿酸尿素<6 mg/dl。主要不良事件（AES），例如异硫醇超敏反应 综合征（AHS）和与秋水仙碱相关的神经病和血液学AE与 显着的发病率和死亡率，尚未通过精心设计，充分动力进行研究 研究该提案的主要目的是研究使用痛风药物安全​​的有效性 国家VA数据库。我们的项目使用NLP算法来开发大型有效国家 痛风患者队列，提取血清尿酸盐水平，并在大型痛风队列中验证和研究AE。 特定目的1：确定与实现的关键患者，提供者和卫生系统因素 并在服用别嘌醇的痛风患者中维持低于6 mg/dl的血清尿酸盐。 特定目的2：表征主要不良事件的流行病学和风险因素（AES） 与使用别嘌醇和秋水仙碱治疗痛风有关。 我们将使用自然语言处理（NLP）算法，其中包含来自国家的丰富信息 VA EHR（诊所注释中的文本现场数据）和全国可用的实验室结果（血清尿素，滑膜 流体结果）除了LCD-9代码外，还可以更准确地识别痛风患者。采用类似的方法，我们 将识别出验证的主要AES痛风患者队列。我们将检查密钥的关联（患者， 医师，医疗保健）具有实现目标血清尿酸盐和大型AE风险的能力的因素。