Mentoring in patient-oriented research in social determinants and atrial fibrillation

指导以患者为中心的社会决定因素和心房颤动研究

• 批准号: 10687127
• 负责人: Jared W. Magnani
• 金额: $ 12.08万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-19 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10687127
• 关键词: Acceleration; Achievement; Address; Adherence; Affect; Anticoagulants; Anticoagulation; Area; Atrial Fibrillation; Award; Cardiology; Cardiovascular Diseases; Censuses; Cessation of life; Clinical; Clinical Investigator; Clinical Sciences; Clinical Trials Design; Communities; Complement; Data; Databases; Dementia; Diagnosis; Disparity; Education; Electronic Health Record; Ethnic Origin; Evaluation; Fellowship; Fostering; Funding; Geographic Information Systems; Guidelines; Health; Health Services; Health Services Research; Healthcare Systems; Heart failure; Home; Household; Income; Individual; Individual Adjustment; Infrastructure; Inpatients; Internal Medicine; Intervention; Investigation; Ischemic Stroke; K-Series Research Career Programs; Literature; Measures; Mediation; Medical Care Costs; Medical center; Medicine; Mentors; Mentorship; Morbidity - disease rate; Myocardial Infarction; National Heart, Lung, and Blood Institute; Neighborhoods; Occupations; Oral; Outcome; Outpatients; Ownership; Participant; Pathway interactions; Patients; Pennsylvania; Pharmaceutical Preparations; Postdoctoral Fellow; Public Health; Public Health Schools; Race; Recruitment Activity; Reporting; Research; Residencies; Resources; Risk; Role; Rural; Stroke prevention; Training; Training Programs; Translational Research; Universities; Visit; Vocation; Warfarin; administrative database; career development; clinical trial recruitment; deprivation; disparity reduction; doctoral student; health equity; improved; innovation; medical schools; metropolitan; multidisciplinary; neighborhood association; novel; patient oriented; patient oriented research; pre-doctoral; prevent; programs; prospective; randomized, clinical trials; residence; rurality; secondary analysis; segregation; social; social determinants; social disparities; social factors; social health determinants; success; thromboembolic stroke; treatment and outcome

Oral anticoagulation is a foremost, guideline-based priority for stroke prevention in individuals with atrial fibrillation (AF), a common condition with high social and medical costs. Social determinants of health (SDOH) contribute to accessibility of anticoagulation and the long-term adherence necessary for stroke prevention. This patient-oriented mentoring research program will (1) examine the relations of individual- and neighborhood- level social factors with oral anticoagulation, and (2) accelerate an innovative health services mentoring program in SDOH and AF and cardiovascular disease. SDOH have had limited investigation in AF, such that the investigations described here will inform how SDOH contribute to disparities in anticoagulation. The investigations build on and leverage the core infrastructure of an active, funded health services research program, the resources of a large, regional health care system, and the availability of large, highly generalizable administrative health claims data. The specific investigatory aims are: (1) Evaluate neighborhood-level SDOH in relation to anticoagulant adherence as measured by proportion of days covered (PDC). This aim will add geocoding to two actively recruiting clinical trials (n=504) which aim to improve adherence to anticoagulation in individuals with limited social resources. (2) Relate neighborhood-level SDOH to anticoagulation. Employing the extensive electronic health record of the University of Pittsburgh Medical Center, the analysis will examine associations of neighborhood-level SDOH with anticoagulation prescribing in individuals with AF in a large, socially heterogeneous region. (3) Examine SDOH in relation to anticoagulant prescription and 1-year adherence in a large administrative database. We will employ Optum Clinformatics to examine individual-level SDOH in relation to PDC from 2015-2021. These investigations will be conducted in the framework of a well-established mentoring program and build on the PI's active mentoring capacity in the Schools of Medicine and Public Health at the University of Pittsburgh. Mentoring activities expand the candidate's role with NHLBI-funded T32 training programs, the University of Pittsburgh cardiology fellowship, internal medicine residency, and pre- and post-doctoral students in the School of Public Health. The project (1) leverages multidisciplinary mentoring opportunities within the University sponsored by the Clinical and Translational Science Institute (CTSI); (2) bolsters mentorship in conduct and design of clinical trials; and (3) extends and broadens the applicant's demonstrated commitment towards mentoring and retention of individuals from groups historically underrepresented in medicine. In summary, the award program will enhance evaluation of SDOH in cardiovascular disease, health services research with large-sized administrative data, and capacities for robust academic, research, and clinical mentoring. This application proposes innovative research in SDOH and cardiovascular disease alongside career development activities for substantive progress and achievement as a mentor in patient-oriented research.

口服抗凝治疗是心房患者预防中风的首要优先级 纤颤（AF），这是一种具有高社会和医疗费用的常见状况。健康的社会决定因素（SDOH） 有助于抗凝性的可及性和预防中风所必需的长期依从性。这 面向患者的指导研究计划将（1）检查个体和邻里的关系 口服抗凝治疗的社会因素，以及（2）加速创新的卫生服务指导 SDOH和AF的计划以及心血管疾病。 SDOH在AF的调查有限，这样 此处描述的调查将告知SDOH如何促进抗凝性差异。这 调查以积极的，资助的卫生服务研究的核心基础设施为基础并利用 计划，大型区域医疗保健系统的资源以及大型，高度的可用性 可推广的行政健康索赔数据。具体的研究目的是：（1）评估 与抗凝剂依从性有关的邻里级别的SDOH，如覆盖的天数所测量 （PDC）。该目标将为两个积极招募临床试验（n = 504）增加地理编码，旨在改善 在社会资源有限的个人中遵守抗凝性。 （2）联系邻里级别的SDOH 进行抗凝。使用匹兹堡大学医学的广泛电子健康记录 中心，分析将检查邻里级SDOH与抗凝处方的关联 患有AF的人在一个大型社会异质地区。 （3）检查与抗凝剂有关的SDOH 大型行政数据库中的处方和1年的依从性。我们将使用optum clenformatics 从2015 - 2021年开始检查与PDC相关的个人级SDOH。这些调查将在 建立良好的指导计划的框架，并建立在PI的主动指导能力上 匹兹堡大学医学和公共卫生学校。指导活动扩展 候选人在NHLBI资助的T32培训计划中的角色，匹兹堡大学心脏病学奖学金， 内科医学驻留，以及公共卫生学院的博士后学生。项目（1） 利用临床赞助的大学内部的多学科指导机会 翻译科学研究所（CTSI）； （2）临床试验的行为和设计指导的指导； （3） 扩展并扩大了申请人对指导和保留的承诺 从历史上讲，来自医学的人数不足。总而言之，颁奖计划将 增强对心血管疾病的SDOH的评估，卫生服务研究 行政数据以及可靠的学术，研究和临床指导的能力。此应用程序 提出了有关SDOH和心血管疾病的创新研究，以及职业发展活动 作为以患者为导向研究的导师的实质性进步和成就。

项目成果

Association of Race and Ethnicity on the Management of Acute Non-ST-Segment Elevation Myocardial Infarction.

• DOI: 10.1161/jaha.121.025758
• 发表时间: 2022-06-21
• 期刊: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• 影响因子: 5.4
• 作者: Tertulien, Tarryn;Broughton, Stephen T.;Swabe, Gretchen;Essien, Utibe R.;Magnani, Jared W.
• 通讯作者: Magnani, Jared W.

Impact of Neighborhood on Cardiovascular Health: A Contemporary Narrative Review.

社区对心血管健康的影响：当代叙事回顾。

• DOI: 10.1007/s11886-023-01919-1
• 发表时间: 2023
• 期刊: Current cardiology reports
• 影响因子: 3.7
• 作者: Fullin,Kerianne;Keen,Susan;Harris,Kathryn;Magnani,JaredW
• 通讯作者: Magnani,JaredW

Association of Depression and Adherence to Oral Anticoagulation in Patients With Atrial Fibrillation.

• DOI: 10.1161/jaha.123.031281
• 发表时间: 2023-11-20
• 期刊: Journal of the American Heart Association
• 影响因子: 5.4

Stressful Life Events, Social Support, and Incident Breast Cancer by Estrogen Receptor Status.

• DOI: 10.1158/1940-6207.capr-22-0472
• 发表时间: 2023-05-01
• 期刊: Cancer prevention research (Philadelphia, Pa.)

Income and antiplatelet adherence following percutaneous coronary intervention.

• DOI: 10.1016/j.ijcrp.2022.200140
• 发表时间: 2022-09
• 期刊: INTERNATIONAL JOURNAL OF CARDIOLOGY CARDIOVASCULAR RISK AND PREVENTION
• 作者: LaRosa, Anna R.;Swabe, Gretchen M.;Magnani, Jared W.
• 通讯作者: Magnani, Jared W.