Overcoming Barriers to Effective Care for Minorities

描述（由申请人提供）：少数民族人口的健康状况可能比多数人差，因为他们较少获得经证实有效的卫生保健服务。改善患者自我管理很可能是改善有效护理提供的关键杠杆点。为增加有效保健服务的提供而采取的干预措施，如果经过精心调整，以解决它们所寻求补救的使用不足问题的具体原因，可能是最有效的。我们现在正在进行许多多机构研究和社区外展项目，以改善对纽约市东部和中部哈莱姆地区少数族裔社区的有效护理。我们建议通过提高哈林区东部和中部病人的自我管理技能，围绕改善健康和减少差异这一主题发展我们的中心。我们中心的研究核心将加强两项已经获得资助的干预试验，以检验同伴主导的患者支持小组干预的有效性（一项针对未控制的高血压患者，另一项针对中风患者）；我们将在第三个已经获得资助的试验中增加一项干预措施，将患有早期乳腺癌的妇女和支持现有社区服务的特定需求相匹配。一个充满活力的社区外展核心，旨在将成功的项目嵌入社区，以最大限度地提高研究结束后这些项目保留的可能性，这将补充这些研究策略。我们将加强与社区领袖和组织的现有联系，并建立新的联系，以保持社区、研究人员和教育工作者之间的信息交流。本中心将在培训活动中追求互补的目标。我们建议深化与北总医院的合作关系，这是除了西奈山以外唯一一家位于哈莱姆东区或中部的私立医院。我们将让North General参与到我们的研究中来，就像我们已经资助的研究一样。我们将启动一个多方面的临床研究培训计划，广泛地介绍临床研究概念和方法，并更深入地吸引选定的北总医院教师，以加强我们社区的少数民族卫生服务研究基础设施，并促进少数民族教师进入研究事业。

DESCRIPTION (provided by applicant): Minority populations may experience poorer health status than the majority because they receive proven effective health care services less often. Improving patient self-management is most likely a critical leverage point in improving the delivery of effective care. Interventions to increase the delivery of effective health care services are likely to be most effective if they are carefully tailored to address the specific causes of the under use problems they seek to remedy. We have many multi-institutional research and community outreach projects underway now to improve the delivery of effective care to the minority communities of East and Central Harlem in New York City. We propose to develop our Center around the theme of improving health and reducing disparities by enhancing self-management skills among patients in East and Central Harlem. Our Center's research core will enhance 2 already-funded intervention trials to examine the effectiveness of a peer-led patient support group intervention (one in patients with uncontrolled hypertension and a second in those with stroke); we will add to a third already-funded trial an intervention that will match women with early-stage breast cancer and specific needs for support to existing community services. A vigorous community outreach core that will aim to embed successful programs in the community to maximize the likelihood that they will remain after the research studies are concluded will supplement these research strategies. We will strengthen existing linkages and build new ones with community leaders and organizations to maintain a mutual exchange of information between the community, researchers, and educators. Our Center will pursue complementary objectives in its training activities. We propose to deepen our partnership with North General Hospital, the only private hospital other than Mount Sinai in East or Central Harlem. We will involve North General in the enhancements to our research studies, as we have with the already-funded research. We will inaugurate a multi-faceted clinical research training program that will introduce clinical research concepts and methods broadly and engage selected North General faculty more intensively to enhance the minority health services research infrastructure in our community and to facilitate the entry of minority faculty into research careers.