hripcsak可重复性研究的进展

1、Observational Health Data Sciences and Informatics (OHDSI)观察性健康医疗数据科学与信息学George Hripcsak, MD, MSBiomedical Informa9cs, Columbia UniversityMedical Informa9cs Services, NewYork-PresbyterianObserva(onal Health Data Sciences and Informa(cs (OHDSI, as “Odyssey”)Mission: To improve health byempowering a c

2、ommutocollabora9vely generate the evidence that promotes beNer health decisions and beNer care使命：通过经过的团队合作，产生科研证据来促进更好的健康决策和更好的健康，健康状况hNp:/OHDSIs global research commu OHDSI遍布全球的合作团队 200 collaborators 200 合作团队 25 countries 25个a billion records 10亿条数据400 million pa9ents4亿数据Broad exper9se广泛的领

3、域交叉 Sta9s9cs 统计学 Epidemiology流行病学 Informa9cs信息学 SoYware engineering软件工程 Clinical medicine临床医学Current problems in research当前研究遇到的问题Most research ques9ons have never been studied大多数研究问题从未被研究过All health outcomes of interest 所有感的健康结果All drugs 所有Unreliable evidence: inconsistent answers for the same ques

4、9on不可靠的证据：同一问题的不一致August 2010: In the UK General Prac9ce Research Database, oral bisphosphonates are not associated with esophageal cancer 2010年8月：在英国全科医学研究数据库中，口服双膦酸盐与食管癌无关Sept2010: In the UK General Prac9ce Research Database, oral bisphosphonates are associated with esophageal cancer2010年9月：在英国全科医

5、学研究数据库中，口服双膦酸盐与食管癌有关OHDSIs approachOHDSI采用的方法Open science开放型科学Open science 开放型科学Data + Analy9cs + Domain exper9se数据 +分析+ 专业领域专家 Open-source soYware 开源的软件 Open processes 开放的流程 Complete transparency完全的透明化Open source soYware 开源软件Enable users to do something 使用户能够做些事情Generate evidence 生成证据Keep data loca

6、l and share results数据保持在本地，只分享结果OHDSI Data Partners OHDSI数据合作伙伴OHDSI Coordina9ng CenterNetworkAnaly9csResearch and supportdevelopmenteduca9on 网络支持开发分析方法研究和教学OHDSI.orgExperimentAnalogyStrengthPlausibilityTemporalityConsistencyCoherenceBiological gradientSpecicityCompara(ve eec(venessPredic(ve modelin

7、gStandardized analy9cs标准化分析All use same data m所有用户使用相同数据模型Standardized health system dataLoca9onCare_siteProviderPayer_plan_periodVisit_occurrenceProcedure_occurrenceCostDrug_exposureDevice_exposureCondi9on_occurrenceCohort_aNributMeasurementCondi9on_eraNoteDrug_eraObserva9onStandardized vocabularie

8、sStandardized derived elementsStandardized health economicsStandardized clinical dataANribute_deni9onCohort_deni9onConcept_ancestorSource_to_concept_maDrug_strengthConcept_synonymRela9onshipConcept_rela9onshipConcept_classDomainVocabularyConceptStandardized meta-dataCDM_sourceFact_rela9onshipDose_er

9、aCohortDeathSpecimenObserva9on_periodTranslate to same vocabularies翻译成相同的词汇术语集OHDSI Benets OHDSI的优势Shared exper9se共享专业知识Resources for crea9ng data m用于创建数据模型的 Costs $600,000 per year 每年花费600,000Network of soYware developerss软件开发网络Sta9s9cians, epidemiologists on methods统计学家，流行病学家的方法Large, diverse data

10、 network庞大而多样的数据网络Co-author on interna9onal projects国际项目的合著作者OHDSI Studies OHDSI的研究Treatment Pathways:how are diseases actually treated?治疗途径：疾病如何得到实际治疗？Global stakeholdersConduitsLocal stakeholdersEvidenceInputsIndica9onFeasibilityCostPreferenceConsultantClinicianPa9entFamilyPublicSocial mediaLay pr

11、essLiteratureGuidelinesAdver9singFormularyLabelsRegulatorIndustryAcademicsRCT, ObsData partners: 250 million records数据合作伙伴：2.5亿条Abbre- via(onNameDescrip(onPopula(on, millionsAUSOMAjou University School of MedicineSouth Korea; inpa9ent hospital EHR2CCAEMarketScan Commercial Claims and EncountersUS pr

12、ivate-payer claims119CPRDUK Clinical Prac9ce Research DatalinkUK; EHR from general prac9ce11CUMCColumbia University Medical CenterUS; inpa9ent EHR4GEGE CentricityUS; outpa9ent EHR33INPCRegenstrief Ins9tute, Indiana Network for Pa9ent CareUS; integrated health exchange15JMDCJapan Medical Data CenterJ

13、apan; private-payer claims3MDCDMarketScan Medicaid Mul9-StateUS; public-payer claims17MDCRMarketScan Medicare Supplemental and Coordina9on of BenetsUS; private and public-payer claims9OPTUMOptum ClinForma9csUS; private-payer claims40STRIDEStanford Transla9onal Research Integrated Database Environmen

14、tUS; inpa9ent EHR2HKUUniversity; EHR1Proceedings of the Na9onal Academy of Sciences, 2016Treatment pathways for diabetes的治疗途径T2DM : All databasesOnly drugFirst drugSecond drugHeterogeneity in treatments治疗中的异质性Japan diers in use of Mepormin (due to gene9cs)在使用二甲双胍方面有所不同（由于遗传）No agreement on depressio

15、n没有抑郁症的一致性Type 2 Diabetes MellitusUSHypertensionCUMCDepressionMDCDUKINPCGEJAPANMDCROPTUMThe current literature is severely biased目前的文献严重偏颇In reality, mostresults are not signicant, but they are never published (missing)实际上，大多数结果并不重要，但从未公布85% of published studies are posi9ve（）的研究中有85 是正面的已Drug protec

16、ts保护性Drug harms有害性29,982 es9mates11,758 papersOHDSIs reproducible research OHDSI的可重复研究Address confounding that is measured1.解决问题Propensity stratification倾向分层2. Address unmeasured confounding解决不可测量的问题3. Multiple databases, locations, practice types多个数据库，地点，练习类型Negative controlsExploit international O

17、HDSI network利用国际OHDSI网络4. Open: publish all开放：全部发布5. Run 17,000 studies at once运行17000次研究Duloxe9ne vs. Sertraline for these 22 outcomes:林的22项结果：度与Acute liver injuryHypotensionAcute myocardial infarc9onHypothyroidismAlopeciaInsomniaCons9pa9onNauseaDecreased libidoOpen-angle glaucomaDeliriumSeizureDia

18、rrheaStrokeFractureSuicide and suicidal idea9onGastrointes9nal hemorrhageTinnitusHyperprolac9nemiaVentricular arrhythmia and sudden cardiac deathHyponatremiaVer9goMany treatments at once大规模治疗DrugAtypicalMirtazapineProcedurePsychotherapyPsychotherapyDrugSNRIDesvenlafaxineDrugSNRIvenlafaxineDrugSSRIEscitalopramDrugSSRIParoxe9neDrugSSRIvilazodoneDrugTCADoxepinDrugTCANortriptylineDrugTCAAmitriptylineDrugSSRISertralineDrugSSRIFluoxe9neDrugSSRICitalopramDrugSNRIduloxe9neDrugSARITrazodoneProcedureECTElectroconvulsive therapyType