Improving the Quality of Heart Failure Care for American Indian Patients Receiving Care through the Indian Health Service

提高通过印第安人卫生服务中心接受护理的美洲印第安人患者的心力衰竭护理质量

• 批准号: 10738653
• 负责人: Lauren A Eberly
• 金额: $ 18.46万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-12 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738653
• 关键词: Address; Advisory Committees; Africa South of the Sahara; Alaska Native; American Indians; Award; Behavior; Cardiovascular Diseases; Cardiovascular system; Caring; Characteristics; Chronic Disease; Clinical; Collaborations; Coronary heart disease; Data; Data Sources; Databases; Devices; Disparity; EFRAC; Ensure; Equity; Face; Familiarity; Funding; Future; General Population; Goals; Guidelines; Health Personnel; Health Priorities; Health Services; Heart failure; Hospitalization; Incidence; Inequity; Institution; Interview; Literature; Maps; Medical; Mentors; Mentorship; Methodology; Modeling; Morbidity - disease rate; Native-Born; Navajo; Outcome; Patient Discharge; Patients; Pharmaceutical Preparations; Pharmaceutical Services; Population; Pragmatic clinical trial; Provider; Public Health; Publishing; Qualitative Research; Quality of Care; Race; Recommendation; Research; Research Methodology; Research Personnel; Research Priority; Research Training; Resources; Rural; Service delivery model; Site; Specialist; Structure; System; Testing; Therapeutic; Time; Training; Tribes; United States; United States Indian Health Service; United States National Institutes of Health; Variant; Vulnerable Populations; Work; access disparities; burden of illness; cardiovascular health; care delivery; career; clinical database; clinical training; combat; cost; effectiveness evaluation; evidence base; health care availability; health disparity; high risk; implementation science; implementation strategy; improved; innovation; marginalization; marginalized population; mortality; patient oriented; racial minority; racial population; service providers; study population; theories; trend; uptake

PROJECT SUMMARY/ABSTRACT Heart failure morbidity and mortality disproportionately impact racial minorities, and inequitable care delivery based on race is pervasive in the United States. While the American Indian/Alaska Native population is one of the populations that suffers most from health disparities, little is known about their burden of cardiovascular disease, particularly heart failure. In fact, there are no studies in the current era evaluating the burden and outcomes of heart failure among the American Indian/Alaska Native population, or the quality of care they receive. The proposed mixed-methods research plan aims to characterize the burden of disease, outcomes, and quality of care of American Indian/Alaska Native patients with heart failure with reduced ejection fraction receiving care through the Indian Health Service— the principal health care provider for the American Indian/Alaska Native population, as well as to determine implementation strategies to ensure quality heart failure care for this population. Aim 1 seeks to characterize the clinical characteristics, as well as rates of guideline directed medical and device therapy and outcomes of American Indian/Alaska Native patients with heart failure receiving care through the Indian Health Service. This aim will utilize a large administrative clinical and claims database. Aim 2 will augment this analyses by employing qualitative research methods to interview American Indian heart failure patients discharged after a heart failure hospitalization, as well as primary providers at two Indian Health Service sites in Navajo Nation to better understand barriers to quality heart failure care. Aim 3 will employ an implementation mapping approach with a stakeholder taskforce at the same sites to determine the highest priority strategies to improve heart failure care for this population. These aims will lead to a future pilot pragmatic clinical trial of American Indians with heart failure in Navajo Nation, which will be used to evaluate the effectiveness of the highest priority strategies to improve care identified in aim 3. These research aims are part of a comprehensive training plan and will be supervised by a mentorship and advisory team consisting of national leaders in health services and implementation science research, and advanced statistical and qualitative methodologies, and will guide my transition to an independently funded research career.

项目概要/摘要 心力衰竭发病率和死亡率对少数族裔和不公平的护理服务产生不成比例的影响 基于种族的歧视在美国很普遍，而美洲印第安人/阿拉斯加原住民就是其中之一。 对于健康差异最严重的人群，人们对其心血管负担知之甚少 事实上，目前还没有研究评估疾病，特别是心力衰竭的负担和情况。 美洲印第安人/阿拉斯加原住民心力衰竭的结果，或他们的护理质量 拟议的混合方法研究计划旨在描述疾病负担、结果、 射血分数降低的美洲印第安人/阿拉斯加原住民心力衰竭患者的护理质量和护理质量 通过印第安人健康服务中心接受护理——美国的主要医疗保健提供者 印第安/阿拉斯加原住民人口，以及确定实施策略以确保心脏质量 目标 1 旨在描述该人群的临床特征以及失败率。 美洲印第安人/阿拉斯加原住民患者的指南指导的医疗和设备治疗及结果 通过印度卫生服务中心接受心力衰竭护理 这一目标将利用大型行政临床。 目标 2 将通过采用定性研究方法进行访谈来增强这种分析。 美洲印第安人心力衰竭患者在心力衰竭住院后出院，以及原发性心力衰竭患者 纳瓦霍族两个印第安健康服务中心的提供者更好地了解优质心脏的障碍 目标 3 将同时与利益相关者工作组一起采用实施映射方法。 网站以确定改善该人群心力衰竭护理的最优先策略。 将导致未来对纳瓦霍族患有心力衰竭的美洲印第安人进行一项试点实用临床试验，该试验 将用于评估目标 3 中确定的改善护理的最高优先策略的有效性。 这些研究目标是综合培训计划的一部分，并将由导师和 由卫生服务实施和科学研究方面的国家领导人组成的咨询小组，以及 先进的统计和定性方法，并将指导我过渡到独立资助的 研究生涯。