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: 10523302
• 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/10523302
• 关键词: Achievement; Address; Adherence; Affect; Anticoagulants; Anticoagulation; Area; Atrial Fibrillation; Award; Cardiology; Cardiovascular Diseases; Censuses; Cessation of life; Clinical; Clinical Investigator; Clinical Sciences; Clinical Trials; Clinical Trials Design; Communities; Complement; Data; Databases; Dementia; Diagnosis; 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; Institutes; 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; Randomized Clinical Trials; Recruitment Activity; Reporting; Research; Residencies; Resources; Risk; Role; Rural; Stroke prevention; Training; Training Programs; Translational Research; Treatment outcome; Universities; Visit; Warfarin; administrative database; base; career development; deprivation; doctoral student; health equity; improved; innovation; medical schools; metropolitan; multidisciplinary; neighborhood association; novel; patient oriented; patient oriented research; pre-doctoral; prevent; programs; prospective; residence; rurality; secondary analysis; segregation; social; social determinants; social disadvantage; social factors; social health determinants; success; thromboembolic stroke

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.

口服抗凝药是心房患者卒中预防的首要、基于指南的优先事项 颤动（AF）是一种常见疾病，社会和医疗费用高昂。健康的社会决定因素（SDOH） 有助于抗凝治疗的可及性和预防中风所需的长期坚持。这 以患者为中心的指导研究计划将 (1) 研究个人和邻里之间的关系 通过口服抗凝药物平衡社会因素，以及 (2) 加速创新的卫生服务指导 SDOH 和 AF 以及心血管疾病方面的计划。 SDOH 对 AF 的调查有限，因此 这里描述的调查将揭示 SDOH 如何导致抗凝差异。这 调查建立在并利用积极的、受资助的卫生服务研究的核心基础设施上 计划、大型区域卫生保健系统的资源以及大型、高水平医疗服务的可用性 可概括的行政健康声明数据。具体调查目的是：（1）评估 社区层面的 SDOH 与抗凝药物依从性的关系（按覆盖天数比例衡量） （PDC）。这一目标将为两项积极招募的临床试验 (n=504) 添加地理编码，旨在改善 社会资源有限的个体坚持抗凝治疗。 (2) 关联街道级SDOH 以抗凝。采用匹兹堡大学医学院广泛的电子健康记录 中心，该分析将检查社区级 SDOH 与抗凝处方的关联 在一个大的、社会异质的地区患有房颤的个体。 (3)检查SDOH与抗凝剂的关系 大型管理数据库中的处方和一年依从性。我们将采用 Optum Clinformatics 来 检查 2015 年至 2021 年与 PDC 相关的个人层面 SDOH。这些调查将在 建立完善的指导计划框架，并以 PI 的积极指导能力为基础 匹兹堡大学医学与公共卫生学院。辅导活动扩大了 候选人在 NHLBI 资助的 T32 培训计划、匹兹堡大学心脏病学奖学金中的角色， 内科住院医师实习，以及公共卫生学院的博士前和博士后学生。项目(1) 利用大学内由临床和临床中心赞助的多学科指导机会 转化科学研究所（CTSI）； (2) 加强对临床试验的实施和设计的指导；和（3） 扩展和扩大申请人对指导和保留的承诺 来自历史上在医学领域代表性不足的群体的个人。总而言之，该奖项计划将 加强SDOH在心血管疾病、健康服务研究中的评价 管理数据以及强大的学术、研究和临床指导能力。这个应用程序 提出 SDOH 和心血管疾病方面的创新研究以及职业发展活动 作为以患者为导向的研究导师取得的实质性进展和成就。