Patient-Centered Outcomes Research (PCOR) helps people and their caregivers communicate and make informed health care decisions, allowing their voices to be heard in assessing the value of health care options. Comparative effectiveness research (CER) is designed to inform health-care decisions by providing evidence on the benefits and harms of different treatment options. The evidence is generated or synthesized from research studies that compare drugs, medical devices, or ways to deliver healthcare. This K24 award will extend the candidate's mentoring program that has allowed him to mentor 14 trainees and junior faculty during the prior cycle. Few clinical researchers in rheumatology are well trained to pursue PCOR or CER. Funding opportunities in these areas are likely to be 1 of few areas of growth in the federal research budget.
The aims noted below will create an innovative set of databases ideal for PCOR and CER and will pursue CER studies with clinical relevance that provide excellent training opportunities. 1. To link an administrative claims database with an electronic medical record (EMR) database for three different rheumatic disease cohorts -- rheumatoid arthritis (RA), osteoarthritis (OA), and gout -- and then examine the agreement between databases. EMR databases have unique strengths and weaknesses that complement the strengths and weaknesses of administrative claims databases. There have been almost no prior attempts to link these two types of databases. We have already received approvals for the linkage, and data are currently being processed. Both databases share a unique identifier, allowing a deterministic linkage. We will assess 4 types of agreement in each cohort: agreement in underlying diagnosis, relevant drug exposures, covariates, and outcomes. 2. To conduct patient-centered outcomes research using the linked databases for these three cohorts. After linking the databases, we will conduct distinct patient-centered outcomes studies.
In Aim 2 a, we will examine the risk of fractures associated with oral glucocorticoids in RA. There have not been similar comparative effectiveness studies assessing whether patients with similar bone mineral density who use oral glucocorticoids are more likely to sustain fragility fractures.
I Aim 2 b, we will examine the role of TJR on all- cause mortality in moderate-severe hip and knee OA. TJR has clear short-term beneficial effects on pain and function, but it may also have long-term benefits, as has been suggested by at least one prior study. Prior work has had substantial limitations that can be overcome by the proposed linked database. Finally, Aim 2c will investigate the potential role of UALT on CVD outcomes. Strong epidemiologic data link hyperuricemia with CVD, but there have been no large studies examining whether treatments such as allopurinol, febuxostat, probenecid, or pegloticase may play a role in reducing CVD.

Public Health Relevance

Patient-Centered Outcomes Research (PCOR) helps people and their caregivers communicate and make informed health care decisions, allowing their voices to be heard in assessing the value of health care options. Comparative effectiveness research (CER) is designed to inform health-care decisions by providing evidence on the benefits and harms of different treatment options. The evidence is generated or synthesized from research studies that compare drugs, medical devices, or ways to deliver healthcare. This K24 award will extend the candidate's mentoring program that has allowed him to mentor 14 trainees and junior faculty during the prior cycle, focusing on PCOR and CER in rheumatology.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Midcareer Investigator Award in Patient-Oriented Research (K24)
Project #
2K24AR055989-06
Application #
8562436
Study Section
Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
Program Officer
Witter, James
Project Start
2008-05-08
Project End
2018-06-30
Budget Start
2013-07-01
Budget End
2014-06-30
Support Year
6
Fiscal Year
2013
Total Cost
$145,700
Indirect Cost
$10,793
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
Yoshida, Kazuki; Hernández-Díaz, Sonia; Solomon, Daniel H et al. (2017) Matching Weights to Simultaneously Compare Three Treatment Groups: Comparison to Three-way Matching. Epidemiology 28:387-395
Lee, Moa P; Lii, Joyce; Jin, Yinzhu et al. (2017) Patterns of Systemic Treatment for Psoriatic Arthritis in the United States: 2004-2015. Arthritis Care Res (Hoboken) :
Feldman, Candace H; Marty, Francisco M; Winkelmayer, Wolfgang C et al. (2017) Comparative Rates of Serious Infections Among Patients With Systemic Lupus Erythematosus Receiving Immunosuppressive Medications. Arthritis Rheumatol 69:387-397
Paik, Julie M; Kim, Seoyoung C; Feskanich, Diane et al. (2017) Gout and Risk of Fracture in Women: A Prospective Cohort Study. Arthritis Rheumatol 69:422-428
Tedeschi, Sara K; Frits, Michelle; Cui, Jing et al. (2017) Diet and Rheumatoid Arthritis Symptoms: Survey Results From a Rheumatoid Arthritis Registry. Arthritis Care Res (Hoboken) 69:1920-1925
Kim, Seoyoung C; Paik, Julie M; Liu, Jun et al. (2017) Gout and the Risk of Non-vertebral Fracture. J Bone Miner Res 32:230-236
Yoshida, Kazuki; Yu, Zhi; Greendale, Gail A et al. (2017) Effects of analgesics on bone mineral density: A longitudinal analysis of the prospective SWAN cohort with three-group matching weights. Pharmacoepidemiol Drug Saf :
Yu, Zhi; Lu, Bing; Agosti, Jenifer et al. (2017) Implementation of Treat to Target for Rheumatoid Arthritis in the US: Analysis of Baseline Data from the TRACTION Trial. Arthritis Care Res (Hoboken) :
Choi, Nam-Kyong; Solomon, Daniel H; Tsacogianis, Theodore N et al. (2017) Comparative Safety and Effectiveness of Denosumab Versus Zoledronic Acid in Patients With Osteoporosis: A Cohort Study. J Bone Miner Res 32:611-617
Lin, Tzu-Chieh; Yoshida, Kazuki; Tedeschi, Sara K et al. (2017) Risk of Hepatitis B Reactivation in Inflammatory Arthritis Patients Receiving Disease Modifying Anti-Rheumatic Drugs (DMARDs): a Systematic Review and Meta-analysis. Arthritis Care Res (Hoboken) :

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