A Personalized, Patient-Centered Approach to Optimizing Lupus Care

优化狼疮护理的个性化、以患者为中心的方法

基本信息

批准号：
10601028
负责人：
April Jorge
金额：
$ 17.5万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-01 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10601028
关键词：
Academy Adverse effects Award Azathioprine Biological Cardiovascular system Caring Clinical Clinical Investigator Clinical Research Decision Analysis Decision Making Disease Doctor of Philosophy Dose Electronic Health Record Environment Epidemiologic Methods Equilibrium Event FDA approved Fellowship Flare Foundations Funding General Hospitals General Population Goals Guidelines Harm Reduction Heterogeneity Hospitalization Hydroxychloroquine Immunosuppressive Agents Infection Internal Medicine K-Series Research Career Programs Life Lupus Machine Learning Maryland Massachusetts Medicine Mentors Mentorship Methodology Methotrexate Modeling Morbidity - disease rate Mycophenolate Ophthalmology Oral Organ Outcome Paper Patient Preferences Patient Recruitments Patients Peer Review Pharmaceutical Preparations Pharmacoepidemiology Physicians Positioning Attribute Premature Mortality Recommendation Research Research Methodology Research Personnel Residencies Retinal Diseases Rheumatology Risk Risk Factors SARS-CoV-2 infection Science Scientist Severity of illness Subgroup Systemic Lupus Erythematosus Training Training Activity Translational Research Treatment outcome Uncertainty United States National Institutes of Health Universities Vision Work adjudication adverse outcome belimumab care outcomes catalyst clinical decision-making clinical epidemiology cohort comorbidity compliance behavior conventional dosing data access data-driven model dosage experience experimental study improved improved outcome infection risk innovation instructor machine learning prediction algorithm medical schools mortality mortality risk novel patient oriented patient oriented research patient stratification personalized medicine predictive modeling preference renal damage risk prediction risk stratification severe COVID-19 skills therapy adverse effect trend

项目摘要

Candidate: April Jorge, MD is an Instructor in Medicine at Harvard Medical School (HMS) and an Assistant in Medicine in the Rheumatology Unit at Massachusetts General Hospital (MGH). After graduating from the University of Maryland magna cum laude, she received her MD from Georgetown University, and she completed her internal medicine residency at Northwestern University. She completed her rheumatology fellowship at MGH, during which she also completed the Harvard Catalyst Clinical and Translational Research Academy and began working with Hyon Choi, MD, DrPH. Dr. Jorge's prior work has resulted in 15 peer- reviewed original papers, with 13 as the first author or co-first author. Her goal is to become an independent investigator and innovative leader in patient-oriented research of systemic lupus erythematosus (SLE). Mentorship, Training Activities, and Environment: Dr. Jorge will conduct the proposed project at MGH under the mentorship of Hyon Choi, MD, DrPH and co-mentorship of Karen Costenbader, MD, MPH and Karen Sepucha, PhD. Dr. Choi is a world-renowned, NIH-funded physician scientist in advanced clinical epidemiology of rheumatic conditions, ranging from common disorders to rare but serious disorders (e.g., SLE). He has served as a mentor for several prior K awardees. Dr. Costenbader is a clinical investigator and expert in SLE who is also an experienced mentor of K awardees. Dr. Sepucha is a leading expert in patient-centered decision science. Dr. Jorge's research will also benefit from the specific expertise of her key collaborators, including advanced clinical epidemiology methods, machine learning prediction algorithms, and decision- analytic modeling. In addition to receiving excellent mentorship, she will acquire new skills through didactics in advanced clinical epidemiology and pharmacoepidemiology, risk prediction, eliciting patient preferences with a mixed methods research approach, and decision-analytic modeling. Research: SLE carries increased risks of multiple comorbidities and double the risk of death compared to the general population. Current treatment is limited in part by few proven medications and adverse treatment effects. The central goal of this research is to improve long-term SLE outcomes by integrating personalized risks of potential harms and benefits with patient preferences to guide the personalized, patient-centered use of key lupus medications. To achieve this goal, she will risk stratify patients for potential harms of treatment, i.e., hydroxychloroquine retinopathy and infection with belimumab use versus other immunosuppressants, and other adverse outcomes, i.e., severe COVID-19 infection (Aim 1). She will elicit patient preferences for SLE treatment through a discrete choice experiment (Aim 2a) and will integrate patient preferences with personalized risks through a multi-criteria decision analysis to determine the optimal hydroxychloroquine dose in SLE care (Aim 2b). Completion of this proposal and training plan will position Dr. Jorge with the vital experience to become an independent clinical investigator in patient-oriented research of SLE.

候选人：April Jorge，医学博士，哈佛医学院 (HMS) 的医学讲师和助理教授马萨诸塞州总医院 (MGH) 风湿病科的医学。毕业后她以优异成绩毕业于马里兰大学，并在乔治敦大学获得医学博士学位，在西北大学完成了内科住院医师实习。她完成了风湿病学麻省总医院的研究员，在此期间她还完成了哈佛催化剂临床和转化研究学院并开始与 Hyon Choi（医学博士、公共卫生博士）合作。 Jorge 博士之前的工作已导致 15 名同行审阅原创论文，其中第一作者或共同第一作者13篇。她的目标是成为一个独立的人系统性红斑狼疮（SLE）以患者为导向的研究领域的研究者和创新领导者。指导、培训活动和环境：Jorge 博士将在麻省总医院开展拟议项目在 Hyon Choi（医学博士、公共卫生博士）的指导下以及 Karen Costenbader（医学博士、公共卫生硕士）和 Karen Costenbader 的共同指导下塞普查博士。 Choi 博士是美国国立卫生研究院 (NIH) 资助的高级临床流行病学领域的世界知名医师科学家风湿性疾病，范围从常见疾病到罕见但严重的疾病（例如系统性红斑狼疮）。他有担任过几位之前的 K 获奖者的导师。 Costenbader 博士是系统性红斑狼疮 (SLE) 的临床研究者和专家他也是 K 获奖者的经验丰富的导师。 Sepucha 博士是以患者为中心的领先专家决策科学。 Jorge 博士的研究也将受益于她的主要合作者的具体专业知识，包括先进的临床流行病学方法、机器学习预测算法和决策分析建模。除了获得出色的指导外，她还将通过以下方面的教学获得新技能先进的临床流行病学和药物流行病学、风险预测，通过混合方法研究方法和决策分析建模。研究：与普通红斑狼疮相比，系统性红斑狼疮导致多种合并症的风险增加，死亡风险增加一倍一般人群。目前的治疗在一定程度上受到经过验证的药物和不良治疗的限制影响。这项研究的中心目标是通过整合个性化治疗来改善 SLE 的长期结果潜在危害和益处的风险与患者偏好，以指导个性化、以患者为中心的使用主要狼疮药物。为了实现这一目标，她将冒着对患者进行分层治疗的潜在危害的风险，即，使用贝利尤单抗与其他免疫抑制剂相比，羟氯喹视网膜病变和感染，以及其他不良后果，即严重的 COVID-19 感染（目标 1）。她将询问患者对 SLE 的偏好通过离散选择实验（目标 2a）进行治疗，并将患者的偏好与通过多标准决策分析来确定最佳羟氯喹剂量的个性化风险 SLE 护理（目标 2b）。完成此提案和培训计划将使豪尔赫博士掌握重要的知识拥有成为以患者为导向的 SLE 研究的独立临床研究者的经验。