Racial disparities in access to high quality hospitals for coronary heart disease

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DESCRIPTION (provided by applicant): The primary goal of this K08 application is to support Dr loana Popescu to become an independent investigator in the area of racial disparities in cardiovascular disease. The application will involve the assimilation of new methodological skills and the analysis of a number of existing health care databases. In support of the application, Dr. Popescu has assembled a team of experienced mentors-Drs. Gary Rosenthal (Department of Internal Medicine), Gerald Rushton (Geography), and Kevin Leicht (Sociology), who bring expertise in complementary methodological areas and who have assisted Dr. Popescu in designing integrated plans for career development and research. The Career Plan includes advanced training in: 1) hierarchical biostatistical modeling and clinical research ethics; 2) the application of spatial analysis and geographic information systems methods in health care; and 3) methods for measuring residential segregation and understanding its sociological roots. These goals will be accomplished through targeted coursework, tutorials, directed readings, and direct research experiences guided by her mentors. The Research Plan will examine the interplay between geography, segregation and health care system factors, in order to build a comprehensive understanding of why black patients are less likely to receive care for acute myocardial infarction, percutaneous coronary intervention, and coronary artery bypass surgery in high quality hospitals. The Research Plan includes three incremental aims that capitalize on a number of national data sources, including: Medicare inpatient and outpatient claims files; US Census data; American Hospital Association surveys; the American Medical Association Physician Masterfile; and Dartmouth Atlas health care market data. Aim 1 will examine the relationship between race, proximity to the admitting and to high quality hospitals, and the likelihood of admission to high quality hospitals. Aim 2 will evaluate the effects of residential segregation on disparities in admissions to high quality hospitals. Aim 3 will examine the effects of patterns of prior outpatient care on disparities in admission to high quality hospitals and will build Dr. Popescu's fluency in analyzing more complex outpatient physician claims files.