Mentoring in community influences on CVD risk

描述（由申请人提供）：这是一个面向患者研究的职业中期研究者奖的提案。这一职业发展奖将使科比-史密斯博士专注于以患者为导向的心血管疾病预防研究，并招募和指导北卡罗来纳大学一些最聪明的年轻科学家进行医疗保健差异研究。她的近期职业目标是：1)通过开发干预措施来预防心血管疾病，并在患者所在社区的背景下解决患者的问题，从而扩大她在有色人种社区参与研究方面的工作；2)了解服务不足社区社区因素对心血管疾病和心血管危险因素的影响及其对医疗保健利用和健康结局的影响；3)提供优秀的指导，创造一个培训环境，支持在心血管预防和结果方面进行高影响力的研究。这项新研究的具体目标包括：1)确定培训当前社区健康顾问作为导航的可行性，将有多种心血管风险因素的居民与当地医疗保健系统联系起来；2)确定导航员对心血管疾病高危社区成员心血管危险因素控制（糖化血红蛋白、身体活动、血压控制、吸烟）和获得护理的影响；3)确定影响心血管危险因素控制和结局的社区和社会因素。这项两组试验将调查导航员在社区外展项目中心血管结果的作用，以改善医疗服务的获取和利用。将在四个地点每一地点使用两至三名导航员。患者将被随机分配到导航干预组或常规患者管理组，并在基线和6个月时进行测量。本研究针对一种疾病状况和重要人群——农村非洲裔美国人的心血管疾病危险因素预防——并在几个重要方面扩展了现有的有效模型。本研究将导航员和患者置于社区（而不是医疗保健系统）中，从而增加了干预的文化相关性。导航系统将支持多种慢性疾病的获取和管理，而不是专注于一种疾病，从而解决服务不足患者多重合并症的现实。最后，通过社区变量增加患者数据，可以全面分析对心血管疾病预防和医疗保健利用的外部影响。

DESCRIPTION (provided by applicant): This is a proposal for a midcareer investigator award in patient-oriented research. This career development award will give Dr. Corbie-Smith the dedicated time to focus on patient-oriented research in cardiovascular disease prevention, and recruit and mentor some of the brightest young scientists at UNC into healthcare disparities research. Her immediate career objectives are: 1) To extend her work in engaging communities of color in research by developing interventions to prevent cardiovascular disease that address patients in the context of their communities; 2) To understand the influence of community factors in underserved communities and their impact on healthcare utilization and health outcomes in cardiovascular disease and cardiovascular risk factors; and 3) To provide outstanding mentorship by creating a training environment that supports the conduct of high impact research in cardiovascular prevention and outcomes. The specific aims for the new research to be supported through this K24 Midcareer Investigator award include 1) Determine the feasibility of training a current cohort of community health advisors as navigators to link residents with multiple cardiovascular risk factors to local healthcare systems; 2) Determine the impact of navigators on cardiovascular risk factor control (HgbA1C, physical activity, BP control, smoking) and access to care for community members at increased risk for cardiovascular disease; 3) Identify community and social factors that influence cardiovascular risk factor control and outcomes. This two-arm trial will investigate the role of navigators on cardiovascular outcomes in community based outreach programs to improve access and utilization of medical services. Two to three navigators at each of the four sites will be utilized. Patients will be randomized to either a navigator intervention or to usual patient management practices, with measurement at baseline and six months. This study targets a disease condition and population of significant importance - CVD risk factor prevention in rural African Americans - and extends an existing effective model in several important ways. This study situates the navigator and patient within the community (rather than the healthcare system) thus increasing the cultural relevance of the intervention. Rather than a focus on one condition, navigators will support access and management of several chronic conditions, thus addressing the reality of multiple co-morbidities in underserved patients. Lastly, augmenting patient data with community variables allows a comprehensive analysis of external influence on cardiovascular disease prevention and healthcare utilization. PUBLIC HEALTH RELEVANCE: The proposed research will advance public health by testing a patient navigator program to improve access to and quality of care for those with heart disease risk factors. The mentoring component will train new researchers to conduct high impact heart disease prevention research.