Mid-Career Transition -- Mapping Paths to Success in Achieving Community-Level He

职业中期转型——绘制实现社区级成功的路径

• 批准号: 8599681
• 负责人: GEORGE S RUST
• 金额: $ 26.44万
• 依托单位: MOREHOUSE SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-03 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8599681
• 关键词: Mid; Career; Transition; Mapping; Paths

DESCRIPTION (provided by applicant): This career-development award will fund the investigator's transition from executive leadership to intellectual leadership in the field of healh equity research. For over twenty years, the investigator has contributed to building the Morehouse School of Medicine, one of four historically-black medical schools in the nation and recently ranked #1 in the nation for achieving a social mission. He also led development of the National Center for Primary Care, a research, training, and resource center focused on achieving health equity. This mid-career award will allow him to transition from executive leadership to focus exclusively on research that seeks to build models of success toward achieving health equity in communities across the U.S. The proposed research will provide a roadmap to success in achieving more optimal and equitable asthma outcomes for all children, with broader application to a wide range of chronic disease outcome disparities across all age groups. In the proposed progression of research, we plan to build on our experience with Medicaid data by adding more sophisticated computer simulation models of health disparities at the community level, and also to add more sophisticated datasets, including clinical data from electronic health records and social determinant data with geospatial data links. We propose to first study the causes of local-area variation in asthma outcome disparities among millions of low-income, Medicaid enrolled children and youth across 29 states. These states hold over 80% of the entire U.S. Medicaid population, and over 90% of African American and Hispanic / Latino enrollees. Specifically, we will further refine our Monte Carlo simulations and Markov modeling to assess the impact of different treatment strategies filtered through real-world patient adherence. We will use multi-level modeling and geospatial analyses to quantify the effect of patient, provider, hospital, and community factors contributing to racial-ethnic and local-area variation in outcomes. We will engage in structural equation modeling to quantify conceptual models that include latent variables such as "poverty" or "quality of care". Finally, we will exploe agent- based modeling (overlaid on community-level geospatial topography) to simulate the complex dynamics of health disparities as they evolve in space over time. We will also refine these models using clinical data from electronic health records, and assess the applicability of these models to other chronic diseases and to overall health outcome disparities. Our ultimate goal is to save lives and decrease suffering by developing computer models that reveal community- specific intervention points most likely to reduce health disparities in each community.

描述（由申请人提供）：这项职业发展奖将资助调查人员从执行领导层到Healh Equity Research领域的知识领导力的过渡。二十多年来，调查人员为建立莫尔豪斯医学院（Morehouse Medainical of Medainical）做出了贡献，莫尔豪斯医学院（Morehouse Medainical）是全国四所历史悠久的医学院之一，最近在全国范围内以实现社会任务而排名第一。他还领导了国家初级保健中心，研究，培训和资源中心的发展，旨在实现健康平等。这项职业中期奖将使他能够从执行领导层过渡，专注于旨在建立成功模型的研究，以实现美国各个社区的健康公平模式，拟议的研究将为所有儿童提供更加最佳和公平的哮喘成果，为所有儿童提供更广泛的应用程序，以实现所有范围跨所有年龄段的年龄段的疾病差异。在拟议的研究进展中，我们计划通过在社区层面添加更复杂的健康差异模型，并添加更复杂的数据集，包括电子健康记录中的临床数据和与地理空间数据链接。我们建议首先研究数百万个低收入，医疗补助招募的儿童和29个州的哮喘结局差异的局部地区差异的原因。这些州持有全美医疗补助人口的80％以上，占非裔美国人和西班牙裔 /拉丁美洲人的90％以上。具体而言，我们将进一步完善我们的蒙特卡洛模拟和马尔可夫建模，以评估通过现实世界患者遵守过滤的不同治疗策略的影响。我们将使用多层次建模和地理空间分析来量化患者，提供者，医院和社区因素的影响，从而导致种族族裔和地方区域变化的结果。我们将进行结构方程建模，以量化包括“贫困”或“护理质量”等潜在变量的概念模型。最后，我们将利用基于代理的建模（覆盖在社区级地理空间地形上），以模拟随着时间的推移在空间中发展的健康差异的复杂动态。我们还将使用电子健康记录中的临床数据来完善这些模型，并评估这些模型对其他慢性疾病的适用性以及对整体健康结果差异。我们的最终目标是通过开发计算机模型来挽救生命并减少痛苦，这些计算机模型揭示社区特定的干预点最有可能减少每个社区的健康差异。