Further Testing of Obesity Risk Prediction Models
The University of Pittsburgh’s latest study on obesity investigates the feasibility of a predictive model to determine patients’ risks of developing any of the following common comorbidities of obesity: type 2 diabetes, atherosclerotic cardiovascular disease, heart failure, sleep apnea, and cancer. Our study team is testing a predictive model developed at another institution by using UPMC electronic health record data and then expanding the model by incorporating several key social determinants of health. Which version of the model will perform better using our real-world data? Our study team is collaborating with the predictive model’s original developers and an industry sponsor to help answer questions facing patients and their clinicians in everyday health care.
Bariatric Surgery Impact on Cancer Screening (BASICS)
The six-site patient-centered BASICS study will use electronic health record data to examine whether cancer screening practices change after bariatric surgery. The study, funded by the National Cancer Institute, includes the University of Pittsburgh, University of Iowa, University of Missouri, Vanderbilt University, Mayo Clinic, and the University of North Carolina. Investigators will assess and measure cancer screening practices in the 3-5 years before, immediately before/preoperatively (1-year), and after bariatric/metabolic surgery (3-5 years or more) compared to matched comparison groups that did not undergo bariatric/metabolic surgery. The work has potential for expansion to broader questions around cancer-related health risks following bariatric surgery.
POPulation-level Screening for Non-Alcoholic Fatty Liver Disease (POPS-NAFLD)
Building upon our previous studies of non-alcoholic steatohepatitis (NASH), this industry sponsored project aims to develop an evidence-based, comprehensive, risk-stratification strategy for non-alcoholic fatty liver disease (NAFLD)/NASH. Existing algorithms that could be used to screen clinical populations for possible NAFLD have limited utility. In this study, we aim to use predictive modeling to leverage existing EHR data to identify adults at high risk of NAFLD and its complications.
Characterizing Obesity and Understanding Stakeholder Perspectives in a Large Integrated Health System
Researchers at the University of Pittsburgh are kicking off (February 2023) a one-year study of obesity using a two-pronged approach. Evidence-based clinical guidelines support the use of behavioral weight loss interventions to prevent obesity-related morbidity and mortality. Yet, obesity diagnoses are frequently not documented, and behavioral treatment is not widely utilized. Anthropologist Megan Hamm and general internist Kathleen McTigue have received funding from an industry sponsor to use EHR data to characterize the patient population that struggles with obesity and describe current obesity management. Resources, opportunities, and barriers to care will be explored through qualitative work with diverse stakeholders. The research team aims to identify the challenges and unmet needs in obesity management and treatment from patient, healthcare provider, and payer perspectives as well as to describe the health and health care utilization of obese patients across the UPMC system.
Understanding and Improving Routine Vaccination Uptake Among Black Patients with Chronic Conditions
This industry-sponsored study utilizes multiple research methods (aggregate data queries and interviews with patients) to learn more about what factors contribute to vaccine hesitancy among Black patients who are at high risk due to their chronic health conditions. The Black Equity Coalition, clinicians, researchers, industry, and patient-engagement specialists are partnering together to improve health and health care in our community by exploring how health care providers can effectively reduce the barriers for patients to seek and receive all their routine and recommended vaccinations.
Cognitive Behavioral Therapy and Real-Time Pain Management Intervention for Sickle Cell via Mobile Applications (CaRISMA)
Funded by PCORI, this clinical trial compared computerized cognitive behavioral therapy (cCBT) against m-Education to see which provides a greater benefit for daily pain. Researchers sought to understand if cCBT provides a greater benefit to depressive symptoms, health care utilization, and opioid misuse behaviors compared to m-Education as well as measure the feasibility of these measures. Read More
Epidemiology of IPF, Incidence, Prevalence and Mortality: Use of Capture Recapture Methods Advance Research
This registry based retrospective cohort study represents the first application of Capture-Recapture to Idiopathic Pulmonary Fibrosis (IPF) and interstitial lung disease (ILD) epidemiology. The study developed a population-based registry in Allegheny County to assess the incidence, prevalence, mortality and risk factors for IPF. The goal of this registry is three-fold: (1) establish a model registry for future collaborative sites to capture prospective patient-based data (2) use epidemiologic data to establish pilot studies in addressing the issues relating to risk factors for IPF development; and (3) address unanswered questions crucial for the characterization and management of IPF. Success with this method can be employed in other regions of the United States to estimate not only the number of cases of IPF but also non-IPF ILD.
Severe Hypertriglyceridemia and Atherosclerotic Cardiovascular Disease
This data-only observational query sponsored by an industry partner examined the incidence and modes of treatment of severe hypertriglyceridemia (sHTG) in multiple health systems across the PaTH Network. Causes of sHTG include both environmental/lifestyle causes (e.g., obesity, alcohol consumption) as well as other medical conditions (e.g., diabetes, insulin resistance). In addition to increased atherosclerotic cardiovascular disease (ASCVD) risk, hypertriglyceridemia is a well-established cause of acute pancreatitis. Based on the results of this study, researchers are looking ahead to developing improved treatment options and standards of care for patients with sHTG.
Estimating the Burden of Nonalcoholic Steatohepatitis Using a Multistate Electronic Health Record Data Network
Sponsored by an industry partner, this observational study used electronic health records from over 11 million patients and concluded that nonalcoholic steatohepatitis (NASH), a fatty liver disease, is significantly underdiagnosed in the United States. Patients experience different comorbidities with varying levels of prevalence based upon the severity of NASH and future publications and projects are underway to continue to explore diagnostic and intervention options.
A Prospective, Observational Standard of Care Study of Patients With Major Depressive Disorder Who Have Had an Inadequate Response to a Selective Serotonin Reuptake/Serotonin-Norepinephrine Reuptake Inhibitor Antidepressant
This is an industry-sponsored multicenter, prospective, 1-year observational study of participants with major depressive disorder (MDD) who have had insufficient response to an SSRI/SNRI (antidepressant) in adults aged 18-74. The goal of the study was to identify participants who will participate in the ECA (external control arm) to serve as a safety comparator for the seltorexant Phase 3 clinical trial as well as to obtain data on the safety and effectiveness of products used under the standard of care of patients who have failed to adequately respond to an SSRI or SNRI. Data was collected continuously from the EHR (electronic health records) starting at baseline (start of the adjunctive treatment) for one year and supplemented by regular clinical outcome assessments occurring every 3 months.
Provider-Targeted Behavioral Interventions to Prevent Unsafe Opioid Prescribing for Acute Non-Cancer Pain in Primary Care
A PCORnet Designated Study incorporating two or more Clinical Research Networks within PCORnet, this study pursued data about the comparative effectiveness of prescriber-targeted behavioral and checklist strategies to 1) prevent initial opioid prescription and 2) increase concordance with safe use guidelines. Specifically, this study focused on primary care patients with acute and chronic non-cancer pain.
PCORnet Bariatric Study
The main goal of the PCORnet Bariatric Study was to provide accurate estimates of the one-, three-, and five-year benefits and risks of the three most common bariatric procedures—Roux-en-y gastric bypass, adjustable gastric banding, and sleeve gastrectomy—with a focus on outcomes that are important to adults and adolescents with severe obesity. These include, (a) changes in weight; (b) remission and relapse of diabetes; and (c) risk of major adverse events. This obesity observational research initiative involved 10 of PCORnet’s Clinical Research Networks (CDRNs) including 53 healthcare organizations and more than 60,000 bariatric patients, with 50% gastric bypass, 10% gastric banding, and 40% sleeve gastrectomy procedures. The study included 900 adolescent bariatric patients (the largest adolescent cohort ever) and more than 17,000 patients with diabetes. Read More
Targeted Interventions to Prevent Chronic Low Back Pain in High Risk Patients (TARGET)
Low back pain (LBP) is one of the most prevalent and disabling conditions for which people seek health care in the US, with a large proportion of patients initially seeking care from their primary care providers (PCPs). This cluster randomized controlled trial compared common, pragmatic, evidence-based, and patient-centered approaches to the treatment of acute LBP within the PCP environment, with the objective of reducing the proportion of people with acute LBP who progress to chronic LBP.