Determinants in Limb Preservation in Hispanics and Native Americans

西班牙裔和美洲原住民肢体保存的决定因素

• 批准号: 10409809
• 负责人: Tze-Woei Tan
• 金额: --
• 依托单位: UNIVERSITY OF ARIZONA
• 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 2022-08-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10409809
• 关键词: Address; Adult; African American population; All of Us Research Program; Amputation; Ankle; Arizona; Belief; Biometry; Blood flow; Caring; Centers for Population Health; Cessation of life; Classification; Clinical; Communities; Community Health Systems; Complex; Complications of Diabetes Mellitus; Cross-Sectional Studies; Data; Development; Diabetes Mellitus; Diabetic Foot; Diabetic Foot Ulcer; Diagnosis; Disease; Early identification; Educational Background; Enrollment; Focus Groups; Foot Ulcer; Funding; Future; Goals; Health; Health Disparities Research; Health Services Accessibility; Health system; Hispanic Americans; Hispanic Populations; Impairment; Individual; Infection; Intervention; Ischemia; Knowledge; Language; Leg; Limb Salvage; Limb structure; Literature; Logistic Regressions; Lower Extremity; Medical Care Costs; Medical Records; Mentorship; Minority; Minority Groups; Modeling; Native Americans; Not Hispanic or Latino; PMI cohort; Participant; Patient Preferences; Patients; Peripheral arterial disease; Population; Prevention; Public Health; Quality of life; Questionnaires; Reporting; Research; Research Methodology; Risk; Risk Factors; Rural Population; Sampling; Science; Severities; Severity of illness; Societies; Socioeconomic Factors; Specialist; Subgroup; Surveys; System; Training; Ulcer; Underserved Population; United States; United States National Institutes of Health; Universities; Visit; Vulnerable Populations; aggressive therapy; biomedical referral center; caucasian American; classification trees; cohort; comorbidity; cost; cultural competence; design; diabetes management; differences in access; ethnic minority; experience; foot; health care availability; health care disparity; health care service utilization; health disparity; health disparity populations; high risk; implementation science; improved; innovation; insight; minority patient; multidisciplinary; patient oriented; patient population; preservation; programs; prospective; racial and ethnic; racial and ethnic disparities; recruit; regression trees; skills; social culture; socioeconomics; targeted treatment; wound; wound healing

ABSTRACT The complications of diabetic foot ulcerations (DFUs) are severe and costly to patients and society. DFUs are quite common: 1 in 4 adults with diabetes will develop a DFU, and 2 out of 3 treated DFUs will recur. Every year, 40,000 individuals lose a leg owing to DFUs. Compared to other groups, Hispanics and Native Americans (NAs) experience a disparate rate of diabetes, foot ulceration, and lower extremity amputation. To date, our understanding of the factors leading to racial and ethnic disparities in major amputations (ankle and above) is limited. Knowledge of the differences in access to care, barriers to limb salvage (amputation prevention), patients' preference in revascularization (improving arterial blood flow for wound healing), and factors related to major amputation are particularly essential to the development of targeted interventions. The goal of this K23 proposal is to address the critical knowledge gap regarding disparities in lower extremity amputations among Hispanics and NAs—vulnerable and often underserved populations. This K23 proposal will leverage the unique and diverse patient populations in the Southwestern Academic Limb Salvage Alliance (SALSA) and the NIH-supported Precision Medicine Initiative Cohort within the All of Us Research Program (AoURP), to determine patient-centered factors that influence the care of the Hispanic and NA populations with DFUs. The objectives of the study include Aim 1: Evaluate the racial and ethnic disparities in healthcare access and utilization among adults with diabetes and DFUs using the cross-sectional survey data of the AoURP; Aim 2: Determine the patient-reported barriers to DFU care and perceived risk factors related to major amputations using focus groups; and Aim 3: Prospectively identify the clinical factors and non-clinical variables (individual, community, and health system-level) related to major amputations among 219 Hispanics and NAs with DFUs. The Classification and Regression Tree (CART) will be used to identify vulnerable subgroups with DFUs that might benefit from early identification and aggressive treatment. The proposed study is significant, as it focuses on the traditionally understudied Hispanic and NA populations. The proposed study is innovative in that it uses the standard Wound, Ischemia, and Foot Infection (WIFi) classification system to stratify the severity of the ulcer presentation. The proposed, rigorous training plan and highly experienced mentorship team composed of national experts in health disparities research, mixed methods research, DFUs and limb salvage, and implementation science will prepare the PI to independently conduct research aimed at designing, conducting, and evaluating culturally competent interventions. Finally, the findings of this study will address a critical knowledge gap regarding disparities in amputations among these vulnerable and underserved groups that continue to make up an increasing portion of the Southwest's population, with the overarching goal of reducing lower extremity amputations among at-risk minority populations.

抽象的 糖尿病足溃疡（DFU）的并发症对患者和社会来说是严重且昂贵的。 dfus是 很常见：四分之一的糖尿病成年人会出现DFU，三分之二的DFU将复发。每一个 一年，由于DFU，有40,000个人失去了一条腿。与其他团体，西班牙裔和美洲原住民相比 （NAS）经历糖尿病，脚溃疡和下肢截肢的不同率。迄今为止，我们的 了解导致主要截肢（踝及以上）种族和种族差异的因素是 有限的。了解获得护理的差异，肢体打捞障碍（预防截肢）， 患者偏爱血运重建（改善了伤口愈合的动脉血流），以及相关因素 主要截肢对于制定有针对性的干预措施尤其重要。目标的目标 K23提案是解决下肢截肢中有关分布的关键知识差距 在西班牙裔和NAS中 - 可诱惑且通常服务不足的人群。该K23提案将利用 西南学术肢体救助联盟（SALSA）和 NIH支持的Precision Medicine Initiative COLORT在美国所有研究计划（AOURP）中， 确定以患者为中心的因素，这些因素会影响使用DFU的西班牙裔和NA人群的护理。 研究的目标包括目标1：评估医疗保健访问中的种族和种族差异 使用AOURP的横断面调查数据在成年人中使用糖尿病和DFU；目标2： 确定患者报告的DFU护理障碍和与重大截肢有关的感知风险因素 使用焦点组；和目标3：前瞻性地确定临床因素和非临床变量（个体， 社区和卫生系统级别）与219名西班牙裔和NAS的主要截肢有关。 分类和回归树（CART）将用于识别具有DFU的脆弱子组 可能会从早期识别和积极的治疗中受益。拟议的研究很重要，因为它专注于 在传统上理解的西班牙裔和NA人群中。拟议的研究具有创新性 标准伤口，缺血和脚感染（WiFi）分类系统，以分层 溃疡表现。拟议的，严格的培训计划和经验丰富的精通团队由 国家健康分布研究，混合方法研究，DFU和肢体救助方面的国家专家 实施科学将为PI做好准备，以独立进行旨在设计，进行，进行，进行，进行，进行的研究 并评估具有文化胜任的干预措施。最后，这项研究的结果将解决关键 这些脆弱和服务不足的群体中截肢差异的知识差距 继续弥补西南人口的越来越多的部分，其总体目标是减少 处于危险的少数群体中的下肢截肢。