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ISCB2014_abstract_book

ISCB 2014 Vienna, Austria • Abstracts - Oral Presentations 11Monday, 25th August 2014 • 9:00-10:30 Monday25thAugustTuesday26thAugustThursday28thAugustAuthorIndexPostersWednesday27thAugustSunday24thAugust Monday, 25th August 2014 – 9:00-10:30 Invited session I1 On trial: integrated care pathways, evidence based medicine and EHRs Organizer: Els Goetghebeur I1.1 Integrated care pathways, evidenced based medicine and electronic health records: an overview MJ Campbell1 1 ScHARR, University of Sheffield, Sheffield, United Kingdom   Integrated care pathways are structured multidisciplinary care plans which detail essential steps in the care of patients with a specific clinical problem. They have been proposed as a way of encouraging the transla- tion of national guidelines into local protocols and their subsequent ap- plication to clinical practice. However, guidelines may be eminence based rather than evidence based, and may be biased or wrong. One of the barriers to integrated care has been the problem of assessing exactly what treatments patients actually receive when their care is split between various providers, particularly between primary and secondary care. In the UK, a new electronic health record (EHR) care.data is being set up to try and provide linked information about the care received from all of the different parts of the health ser- vice, including hospitals and general practitioners. This has had numerous teething problems, particularly with failure to reassure patients about con- fidentiality. Existing general EHRs in the UK include the Hospital Episodes Statistics (HES) and the Clinical Practice Research Database (CPRD), and there are a number of disease specific ones, including the DAFNE database for patients with Type 1 diabetes. This talk will summarise the evidence for the efficacy of integrated care pathways, and describe some of the worst excesses of clinical guidelines. The use of HES and the DAFNE data base in particular for evaluating hos- pitals and care of patients with Type 1 diabetes respectively will be dis- cussed. The prospects of research with care.data will be touched upon. I1.2 From idealized to realized: learning about dynamic treatment regimens using electronic medical records? EEM Moodie1 , DA Stephens1 1 McGill University, Montreal, Canada Due to the cost and complexity of conducting a sequential multiple as- signment randomized trial, learning about optimal treatment from non- experimental data is highly attractive -- particularly with the use of rou- tinely collected data on a large number of people. However the use of electronic medical records presents several challeng- es. For example, visit times are patient-driven and are frequently related to outcomes. Simulations can therefore provide an important first step into estimating optimal rules, and understanding possible biases that may arise in an electronic medical record setting. In this presentation, I will present a simulation design for a complex, con- tinuous dosing problem, and discuss ongoing work in which we relax ide- alized assumptions and move towards more realistic scenarios. I1.3 A causal inference approach to optimising care pathways in type 2 diabetes using electronic health records RA Emsley1 1 Centre for Biostatistics, The University of Manchester, Manchester, United Kingdom Electronic health records such as CPRD provide a rich data source for identifying personalised care pathways in conditions such as diabetes. Marginal structural models can be used to estimate these optimal dynam- ic treatment regimes, but one significant challenge to their application is that measurement times in CPRD are largely patient-driven, and so follow- up times vary in frequency and duration by each patient, and are related to the outcome being considered. In the UK, the prevalence of diabetes has increased dramatically and af- fects approximately 4.6% of the population; in 2012, 2.6 million people were newly diagnosed with type 2 diabetes mellitus. Many of these will de- velop serious disease-related outcomes and microvascular complications can serve as an early marker for later complications. Diabetes manage- ment is based on NICE (National Institute for Health and Care Excellence) guidelines based on repeated glycated haemoglobin (HbA_1c) values. We wish to personalise the treatment pathway for patients dependent on their characteristics, allowing for the variable measurement occasions. We will illustrate the methods with an inception cohort of 41,825 newly diagnosed type 2 diabetes patients initiating an antidiabetic medication (ADM) within CPRD. Of these, over 12,000 proceed onto dual therapy regi- mens and 3,500 develop microvascular complications. We describe the patterns and choice of the first ADM, consider its effect on HbA1c levels and identify the optimal choice of dual therapy to control hbA_1c and de- lay onset of microvascular complications. This work is part of the MRC Health eResearch Centre of the Farr Institute for Health Informatics Research.

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