Author:
Hripcsak George,Ryan Patrick B.,Duke Jon D.,Shah Nigam H.,Park Rae Woong,Huser Vojtech,Suchard Marc A.,Schuemie Martijn J.,DeFalco Frank J.,Perotte Adler,Banda Juan M.,Reich Christian G.,Schilling Lisa M.,Matheny Michael E.,Meeker Daniella,Pratt Nicole,Madigan David
Abstract
Observational research promises to complement experimental research by providing large, diverse populations that would be infeasible for an experiment. Observational research can test its own clinical hypotheses, and observational studies also can contribute to the design of experiments and inform the generalizability of experimental research. Understanding the diversity of populations and the variance in care is one component. In this study, the Observational Health Data Sciences and Informatics (OHDSI) collaboration created an international data network with 11 data sources from four countries, including electronic health records and administrative claims data on 250 million patients. All data were mapped to common data standards, patient privacy was maintained by using a distributed model, and results were aggregated centrally. Treatment pathways were elucidated for type 2 diabetes mellitus, hypertension, and depression. The pathways revealed that the world is moving toward more consistent therapy over time across diseases and across locations, but significant heterogeneity remains among sources, pointing to challenges in generalizing clinical trial results. Diabetes favored a single first-line medication, metformin, to a much greater extent than hypertension or depression. About 10% of diabetes and depression patients and almost 25% of hypertension patients followed a treatment pathway that was unique within the cohort. Aside from factors such as sample size and underlying population (academic medical center versus general population), electronic health records data and administrative claims data revealed similar results. Large-scale international observational research is feasible.
Funder
HHS | NIH | U.S. National Library of Medicine
HHS | NIH | National Institute of General Medical Sciences
National Science Foundation
Smart Family Foundation
Publisher
Proceedings of the National Academy of Sciences
Cited by
249 articles.
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