Understanding and Addressing Racial Disparities in Guideline-Indicated Management of Symptomatic Peripheral Artery Disease

项目总结和摘要 我是一名流行病学家，也是宾夕法尼亚大学外科系的终身助理教授。 北卡罗来纳州，位于查佩尔山。通过奖学金，我将致力于我的职业生涯，以提高 有症状的外周动脉疾病（PAD）患者的护理和结局。我有研究生训练， 生物工程（MS，'03）、医学、健康与社会（MA，'10）和流行病学（PhD，'16）。虽然我 在流行病学方法方面受过特殊的培训，并有长期的流行病学背景， 研究，我以前的大部分工作是在一个支持的角色，我想进入我缺乏的领域枢轴 培训和专业知识。因此，K01奖项的总体目标是为我提供培训， 指导差距和干预研究，旨在减少差距，这是成为 独立的科学家。为了实现这一总体目标，我组建了一个国际知名的团队， 在我的申请中所描述的主题和方法方面具有专业知识的学者。我的主要导师是博士。 Samuel Cykert是医疗保健相关种族差异的专家，也是R01资助的研究人员， 在设计和实施成功的干预措施以减少这些差距方面的经验。我的共同导师 是Adil Haider博士，一位研究隐性偏见在医疗保健相关种族差异中的作用的专家， 有着重大R级资金历史的调查员菲利普古德尼博士将提供他的专业知识， 作为一名资深执业血管外科医生和血管质量倡议主席， 研究咨询委员会。他们三个都完全致力于这个项目和我的成功。的 研究计划的目的是首先确定在提供指导方针方面存在的种族差异， 使用全国代表性血管质量倡议登记处推荐的护理， 在美国536个地点进行的血管手术。第二，我将管理隐含的 对血管外科医生进行关联测试，以检查隐含的种族偏见，并确定这些偏见是否 与实际临床结果相关。最后，我将结合这些第一部分的调查结果， 研究计划，以设计一项干预措施，旨在减少在提供与PAD有关的 保健我将通过评估外科医生的可接受性和实用性来对干预措施进行试点测试， 有症状的PAD患者。我推荐的课程，研讨会，会议，和其他 教育机会来完善我的训练。我在职业发展方面设定了五个目标 这些活动中的每一项都与这五个目标中的一个或多个目标直接相关。成功 该项目完成后，将提交R01，旨在测试多中心干预，并允许我 成为一名独立的调查员，在一个最佳护理可以 降低发病率和死亡率。

PROJECT SUMMARY AND ABSTRACT I am an Epidemiologist and a tenure-track Assistant Professor in the Department of Surgery at the University of North Carolina at Chapel Hill (UNC). Through scholarship, I will devote my professional career to improving the care and outcomes for people with symptomatic peripheral artery disease (PAD). I have graduate training in Bioengineering (MS, ’03), Medicine, Health and Society (MA, ’10), and Epidemiology (PhD, ’16). While I have exceptional training in epidemiology methods and have a long background of conducting epidemiologic research, the majority of my previous work was in a support role and I want to pivot into areas where I lack training and expertise. The overall goal of this K01 award, therefore, is to provide me with the training and mentorship in disparities and in intervention research aimed at reducing disparities that are critical to becoming an independent scientist. To accomplish this overall goal, I have assembled a team of internationally renowned scholars with expertise in the topics and methods described in my application. My primary mentor is Dr. Samuel Cykert, an expert in health care-related racial disparities and an R01-funded investigator with experience in designing and implementing successful interventions to reduce these disparities. My co-mentor is Dr. Adil Haider, an expert in the role of implicit bias in health care-related racial disparities, and an investigator with a significant history of R-level funding. Dr. Phillip Goodney will lend his expertise and credibility as a senior-level, practicing vascular surgeon and as the Chair of the Vascular Quality Initiative Research Advisory Committee. Each of the three are fully committed to this project and to my success. The research plan is designed to first identify the presence of racial disparities in the delivery of guideline- recommended care using the nationally representative vascular quality initiative registry, a database of vascular procedures performed across 536 locations in the US. Second, I will administer the implicit association test to vascular surgeons to examine implicit racial bias and determine if those biases are correlated with actual clinical results. Finally, I will incorporate the findings from these first components of the research plan into the design of an intervention aimed at reducing disparities in the delivery of PAD-related health care. I will pilot test the intervention by assessing acceptability and utility among surgeons who care for patients with symptomatic PAD. I have recommended coursework, workshops, conferences, and other educational opportunities to round out my training. I have set up five objectives regarding career development and each of these activities is directly related to one or more of those five objectives. The successful completion of this project will lead to an R01 submission designed to test a multi-site intervention and allow me to become an independent investigator who can contribute to health equity in an area where optimal care can attenuate substantial morbidity and mortality.