AIM-AHEAD Year 4 Research Fellowship - Project 2234 Dataset

Project Title: Digital Twins Enabled Framework for Modeling Health Systems and Delivery of Care Project Awardee: Alan Pan This dataset is derived from the OCHIN Community Health Database – AIM‑AHEAD Year 4 and implemented as a set of views. It includes adults aged 18 and older with at least one ambulatory or telehealth visit between 2012 and 2024, focusing on patients with a diagnosis of heart failure or diabetes, as well as a comparison population without these conditions to support longitudinal modeling of care trajectories and outcomes. The dataset includes patient demographics (sex, age, race, ethnicity, language, payer, federal poverty level, and ZIP/ZCTA), visit‑level data, provider and care site characteristics, vital signs (blood pressure, BMI, height, weight, tobacco use), condition diagnoses related to cardiometabolic and cerebrovascular disease, mortality indicators, and longitudinal encounter data needed to characterize care pathways, utilization patterns, and clinical outcomes. If you are interested in learning more about this dataset and understanding access requirements, we recommend you reach out to the named Project Awardee and/or OCHIN at AI‑DataConsult[at]ochin.org.