我们如何监测和了解莱姆病的趋势?

挑战

莱姆病的监测情况, 特别是在高发地区, has shifted with a recent change to laboratory-based reporting criteria no longer requiring reporting of clinician-diagnosed cases. This change has created a need for new data sources to estimate incidence 和 monitor trends in the epidemiology 和 临床表现 of Lyme disease in these areas.

Electronic health records (EHRs) are a promising potential source of data for monitoring trends in Lyme disease. 电子病历数据已用于评估莱姆病流行病学, 以及几种结合诊断代码的算法, 测试订单, 抗生素配药已被提议用于病例识别. With respect to constructing optimal case identification algorithms, there is room for improvement.

The Surveillance-Based Lyme Disease (SubLyme) Network is a collaboration between CDC’s National Center for Emerging 和 Zoonotic Infectious Diseases, 趣赢平台, 和 5 health care systems aimed at using EHR data to supplement 和 enhance traditional Lyme disease surveillance.

解决方案

在这项监测研究中, 趣赢平台 is working with CDC 和 5 health care systems in areas with a high Lyme disease burden to establish a virtual epidemiology network. This network will gather EHR data from these health care systems 和 use these data to generate Lyme disease incidence estimates 和 support in-depth studies of epidemiology, 临床表现, 和, 产品应该上市吗, 疫苗的影响.

这个项目的目标是:

1. 制定和测试基于ehr的莱姆病病例定义.
2. Apply these definitions across disparate health care systems to estimate local Lyme disease incidence.
3. Use these definitions as the starting point for additional EHR-based studies of Lyme disease epidemiology.

The definitions to be tested include both traditional public health-style case definitions 和 machine learning-derived definitions.

趣赢平台 serves as the data coordinating center for this network 和 is responsible for developing protocols, 协调数据收集工作, 分析数据, 促进网络伙伴之间的协作.

该项目第一年的重点是以下任务:

1. 建立关系网. 趣赢平台 is working with major health care systems that are directly contracted with CDC to collect EHR data on a well-defined cohort of patients 和 also provide a validation set (both cases 和 non-cases) to be used for the production 和 validation of a set of case definitions. Included in the data provided by sites will be dates related to Lyme disease events, 比如相遇的日期, 诊断测试日期, 用药日期和高级地理信息.
2. 建立一套基于电子病历的病例定义. 使用验证数据, 我们将根据电子病历数据产生一系列候选病例定义. These definitions will include both traditional surveillance case definition algorithms 和 classification tree–based machine learning approaches. We will evaluate the performance of these definitions 和 decide on one or more to use for incidence estimation 和 defining the population to be used for later studies.
3. 产生和常规的发病率估计. 使用案例定义或根据验证数据建立的定义, we will estimate Lyme disease incidence in the cohort defined by each health care system. An interim estimate will be provided during the peak Lyme disease transmission season along with a final estimate later in the year.

在试点阶段之后, we will support a series of more in-depth analyses to complement the ongoing incidence estimation. Tasks for this full network phase will include developing a framework for supplemental studies 和 conducting 疫苗的影响 assessments, 产品应该上市吗.

结果

通过这些努力, 趣赢平台 will provide CDC with a new data stream for situational awareness of 和 research into Lyme disease. This will complement existing public health reporting by providing greater insight into the clinical incidence of Lyme disease without relying exclusively on laboratory-based surveillance. The goal for this work is to ultimately provide the framework for the future of Lyme disease surveillance 和 enhance CDC’s capacity to identify 和 respond to trends in Lyme disease incidence.