: Rising cost of healthcare fostered the demand for mechanisms to ensure money being spent wisely and the need for good comparative effectiveness (CE) information. The applicant who was trained in cardiology and advanced epidemiologic methods with a wealth of experience in CE studies aspires to improve methods of CE research for cardiovascular disease (CVD) using large databases that can potentially produce highly generalizable and directly applicable CE evidence. Specifically, the applicant will 1) develop new databases to study CE of therapies in patients with heart failure (HF) and coronary artery disease (CAD) by linking large claims databases from Medicaid, state pharmacy assistance programs, and Medicare with large clinical registries of CAD and HF and 2) develop and evaluate models for 3 analytic techniques A) high dimensional propensity score using data mining techniques, B) instrumental variable analysis, and C) propensity score calibration to combat bias due to lack of detailed clinical information in claims data research assessing CE of therapies in HF and CAD. When evaluating the validity of these analytic techniques in claims data analyses, the new databases linking claims and registries will be used as the gold standard. CAD will serve as an example when claims data lack information on potential confounders (e.g., disease severity) and HF will serve as an example when claims data also lack potential effect modifiers (e.g., ejection fraction). These proposed methods will be assessed using 4 clinically relevant CE questions: 1) angiotensin-converting enzyme inhibitors (ACEIs) vs. angiotensin II receptor blockers (ARBs) after myocardial infarction, 2) atorvastatin vs. other statins after acute coronary syndrome, 3) ACEIs vs. ARBs for HF, and 4) implantable cardioverter-defibrillators vs. medical therapy for HF. The applicant will have a full access to the aforementioned data sources and full support from collaborators, Drs. Sebastian Schneeweiss (epidemiology method), Robert Glynn (statistics), Lynne Stevenson (cardiovascular care), Francis Cook (data mining) and Richard Gliklich (registries). The applicant will enroll in coursework and attend seminars for statistics to hone skills in advanced analytic methods. She will also attend local and national seminars/conferences for CVD to update relevant clinical knowledge. This award would play an important role in the applicant's development as an outstanding researcher who can provide leadership in CE research for CVD, especially in large database methods.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Scientist Development Award - Research (K02)
Project #
5K02HS017731-06
Application #
8325847
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Anderson, Kay
Project Start
2008-09-30
Project End
2013-09-29
Budget Start
2012-09-30
Budget End
2013-09-29
Support Year
6
Fiscal Year
2012
Total Cost
Indirect Cost
Name
Duke University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Chen, Chih-Ying; Stevenson, Lynne Warner; Stewart, Garrick C et al. (2015) Real world effectiveness of primary implantable cardioverter defibrillators implanted during hospital admissions for exacerbation of heart failure or other acute co-morbidities: cohort study of older patients with heart failure. BMJ 351:h3529
Jalbert, Jessica J; Ritchey, Mary Elizabeth; Mi, Xiaojuan et al. (2014) Methodological considerations in observational comparative effectiveness research for implantable medical devices: an epidemiologic perspective. Am J Epidemiol 180:949-58
Setoguchi, Soko; Warner Stevenson, Lynne; Stewart, Garrick C et al. (2014) Influence of healthy candidate bias in assessing clinical effectiveness for implantable cardioverter-defibrillators: cohort study of older patients with heart failure. BMJ 348:g2866
Halava, Heli; Korhonen, Maarit Jaana; Huupponen, Risto et al. (2014) Lifestyle factors as predictors of nonadherence to statin therapy among patients with and without cardiovascular comorbidities. CMAJ 186:E449-56
Kumamaru, Hiraku; Judd, Suzanne E; Curtis, Jeffrey R et al. (2014) Validity of claims-based stroke algorithms in contemporary Medicare data: reasons for geographic and racial differences in stroke (REGARDS) study linked with medicare claims. Circ Cardiovasc Qual Outcomes 7:611-9
Setoguchi, Soko; Zhu, Ying; Jalbert, Jessica J et al. (2014) Validity of deterministic record linkage using multiple indirect personal identifiers: linking a large registry to claims data. Circ Cardiovasc Qual Outcomes 7:475-80
Palmsten, Kristin; Hernández-Díaz, Sonia; Huybrechts, Krista F et al. (2013) Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States. BMJ 347:f4877
Palmsten, Kristin; Huybrechts, Krista F; Michels, Karin B et al. (2013) Antidepressant use and risk for preeclampsia. Epidemiology 24:682-91
Chen, Chih-Ying; Stevenson, Lynne Warner; Stewart, Garrick C et al. (2013) Impact of baseline heart failure burden on post-implantable cardioverter-defibrillator mortality among medicare beneficiaries. J Am Coll Cardiol 61:2142-50
Palmsten, Kristin; Huybrechts, Krista F; Mogun, Helen et al. (2013) Harnessing the Medicaid Analytic eXtract (MAX) to Evaluate Medications in Pregnancy: Design Considerations. PLoS One 8:e67405

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