Determining disparities in treatment of pulmonary arterial hypertension nationally

确定全国肺动脉高压治疗的差异

• 批准号: 10017704
• 负责人: Kari Gillmeyer
• 金额: $ 8.04万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10017704
• 关键词: Action Research; Address; Affect; Age; Algorithms; American; Award; Boston; Cardiac Catheterization Procedures; Cardiopulmonary; Caring; Chest; Clinical; Code; Cohort Studies; Collection; Communities; Community Practice; Data; Development; Diagnosis; Diagnostic; Diagnostic Procedure; Diagnostic tests; Disease; Disease Surveillance; Early Diagnosis; Economics; Ensure; Environment; Event; Exclusion; Foundations; Goals; Gold; Grant; Guidelines; Health Services; Healthcare; Healthcare Systems; ICD-9; Inequality; Integrated Delivery of Health Care; Integrated Health Care Systems; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10); K-Series Research Career Programs; Lung; Medical center; Mentors; Modeling; Morbidity - disease rate; Neighborhood Health Center; Outcome; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Pharmacy facility; Population; Publishing; Pulmonary Heart Disease; Pulmonary Hypertension; Recommendation; Research; Research Personnel; Research Project Grants; Research Proposals; Series; Severity of illness; Societies; Socioeconomic Status; Specificity; Subgroup; Symptoms; System; Training; Validation; Vasodilator Agents; Veterans; Work; base; biomedical referral center; care delivery; career; cohort; comorbidity; data registry; data resource; demographics; diagnostic accuracy; disparity reduction; ethnic minority population; health administration; health care delivery; health care disparity; health care service utilization; health disparity; hypertension control; hypertension treatment; improved; improved outcome; insight; low socioeconomic status; pulmonary arterial hypertension; racial and ethnic; rurality; skills; socioeconomics; sound; systematic review; targeted treatment; tool; treatment as usual; treatment disparity

PROJECT SUMMARY/ABSTRACT Pulmonary arterial hypertension (PAH) is a severe disease of the pulmonary vasculature characterized by high symptom burden, significant healthcare utilization, and poor survival. Recently developed targeted therapies have improved outcomes for patients with PAH; however, the disease remains significantly underrecognized and undertreated when patients are managed outside of PAH referral centers. Despite the importance of early diagnosis and initiation of treatment in altering the disease trajectory, little is known about the influences on PAH care on a population level including potential patient-, environment-, or system-level determinants of treatment for PAH. Single-center studies suggest that disparities in PAH outcomes may exist among different racial/ethnic or socioeconomic status groups, though the factors that account for these differences such as disparities in treatment rates among these populations remain to be determined. Expanding our understanding of PAH care beyond PAH registry data and single-center cohort studies is essential to close care gaps on a population level. Administrative data that captures care within a national, diverse, integrated health system such as the Veteran’s Health Administration (VA) can serve as an important tool to improve our understanding of the delivery of PAH care in usual community practice and to detect health disparities in PAH. To capitalize on this rich data resource for this purpose, we must first establish sound mechanisms to identify PAH in administrative data, mechanisms that are currently lacking in this field. I propose two foundational steps to enhance our understanding of the drivers of PAH care delivery in the community and to fill currently unmet needs in PAH research: 1) create and validate algorithms to differentiate PAH from other, more common forms of pulmonary hypertension in administrative data and 2) identify patient- and facility-level determinants of treatment for PAH. Completion of this research proposal will advance the field of PAH by generating a collection of validated tools that other PAH researchers can utilize to better address diverse research questions and by revealing drivers of PAH care delivery on a population level including racial/ethnic and economic disparities in treatment rates. The results of this study will establish a foundation on which to build and implement effective strategies to improve treatment rates and mitigate health disparities for patients with PAH. Meanwhile, the skills I gain through this mentored research project and complementary didactic training will advance my career goal of becoming a leading independent investigator focused on identifying and addressing cardiopulmonary health disparities.

项目概要/摘要 肺动脉高压（PAH）是一种严重的肺血管疾病，其特征是血压升高 症状负担、大量的医疗保健利用以及最近开发的靶向疗法的不良生存率。 改善了 PAH 患者的预后；然而，该疾病仍然未被充分认识 尽管早期治疗很重要，但当患者在 PAH 转诊中心之外接受治疗时，治疗仍不足。 诊断和开始治疗可以改变疾病轨迹，但对 PAH 的影响知之甚少 人口层面的护理，包括潜在的患者、环境或系统层面的治疗决定因素 单中心研究表明，不同种族/民族之间的 PAH 结果可能存在差异。 或社会经济地位群体，尽管造成这些差异的因素，例如收入差距 这些人群的治疗率仍有待确定，以扩大我们对 PAH 护理的了解。 除了 PAH 登记数据和单中心队列研究之外，对于缩小人口层面的护理差距至关重要。 记录国家、多元化、综合卫生系统（例如退伍军人医疗系统）内护理的管理数据 卫生管理局 (VA) 可以作为一个重要工具来提高我们对 PAH 治疗的了解 日常社区实践中的护理并检测 PAH 的健康差异，以利用这一丰富的数据资源。 为此，首先要建立健全行政数据中PAH识别机制、机制 我提出了两个基本步骤来增强我们对这一领域的理解。 社区 PAH 护理服务的驱动因素，并满足 PAH 研究中当前未满足的需求：1）创建和 验证区分 PAH 与其他更常见形式的肺动脉高压的算法 管理数据；2) 确定患者和机构层面的 PAH 治疗完成的决定因素。 该研究提案将通过生成一系列经过验证的工具来推进 PAH 领域的发展 研究人员可以利用它来更好地解决不同的研究问题，并揭示 PAH 护理的驱动因素 人口层面的交付情况，包括治疗率方面的种族/民族和经济差异。 这项研究将为制定和实施有效策略以改善治疗奠定基础 同时，我通过这种指导获得的技能也得到了提高。 研究项目和补充性教学培训将推进我成为领先者的职业目标 独立调查员专注于确定和解决心肺健康差异。