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

这个K 08应用程序的主要目标是支持博士loana Popescu成为一个独立的 心血管疾病种族差异领域的研究者。申请将涉及 吸收新的方法技能和分析一些现有的卫生保健数据库。在 为了支持这项申请，Popescu博士组建了一个由经验丰富的导师组成的团队--加里博士 Rosenthal（内科），Gerald Rushton（地理）和Kevin Leicht（社会学）， 他们带来了补充方法领域的专业知识，并协助Popescu博士 制定职业发展和研究的综合计划。 职业计划包括以下方面的高级培训：1）分层生物统计建模和临床研究 伦理学; 2）空间分析和地理信息系统方法在医疗保健中的应用;以及 3)衡量居住隔离和了解其社会学根源的方法。这些目标将 通过有针对性的课程，辅导，指导阅读和直接的研究经验来完成 在导师的指导下 研究计划将研究地理、隔离和保健制度之间的相互作用 因素，以便全面了解为什么黑人患者不太可能接受护理 用于急性心肌梗死、经皮冠状动脉介入治疗和冠状动脉搭桥手术， 优质医院。该研究计划包括三个渐进的目标，利用了一些 国家数据来源，包括：医疗保险住院和门诊索赔文件;美国人口普查数据;美国 医院协会调查;美国医学协会医师主文件;和达特茅斯地图集 医疗保健市场数据。目标1将研究种族、接近接纳和 高质量的医院，以及进入高质量医院的可能性。目标2将评估 居住隔离对高质量医院收治率差异的影响。目标3将检查 既往门诊治疗模式对高质量医院入院差异的影响， 建立波佩斯库博士在分析更复杂的门诊医生索赔文件的流畅性。 相关性（参见说明）： 尽管国家持续关注，但在对种族不平等原因的研究方面仍存在重大差距， 心血管疾病拟议的项目将为阐明 地理和社会环境因素造成了这些持续的差异。

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 DartmouthAtlas 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. RELEVANCE (See instructions): Despite sustained national attention, significant gaps remain in research on causes of racial disparities in cardiovascular disease. The proposed projects will bring an important contribution to elucidating the geographic and social context factors contributing to these persistent disparities.