Quality and Equity in Osteoarthritis: Understanding & Improving Treatment Use

 应聘者描述：应聘者职业目标：Ernest R.Vina博士的长期职业目标是通过开发干预措施来消除种族差异并改善这些疾病患者的预后，以促进风湿性和肌肉骨骼疾病患者的公平。凭借他在解决风湿病患者健康和保健方面的种族差异来源方面的研究和临床经验，维纳博士非常适合在这一领域建立研究事业。然而，他将需要更多的培训和技能，以便通过探索患者特征和健康信念来解决知识差距，这些特征和健康信念可能导致骨关节病患者的医疗保健差异。维纳博士的短期职业目标是：1)发展所需的专业知识，研究不同类型的非手术骨性关节炎治疗中存在种族差异的原因；2)学习制定干预措施并实施临床试验，以减少各种骨性关节炎治疗中的种族差异。研究背景：骨性关节炎是一种高度流行的致残性疾病。骨性关节炎患者预后的种族差异也已被证明，非裔美国人(AA)比白人(WHS)负担更大。此外，AA也不太可能有使用各种药物和非药物疗法治疗OA的历史。OA中种族保健差异的来源仅部分为人所知。研究目标：这款K23的主要目标有两个。第一个是检查各种OA治疗的决定因素和障碍，这些治疗导致在AA和WHS的护理方面存在差异。第二项是对旨在提高有效的非手术骨性关节炎治疗利用率的干预措施的影响进行试点测试。方法：为达到第一个目标，将对膝关节或髋关节骨性关节炎患者进行调查。调查将确定患者的人口统计信息、心理社会特征、疾病严重程度、治疗史以及与健康相关的知识、信念和态度。令人感兴趣的主要结果将包括使用各种治疗方法，包括锻炼、外用药物、非类固醇消炎药和阿片类药物。将进行分级统计建模，以确定哪些患者水平的变量可能在各种OA治疗的使用中调节种族差异。对于第二个目标，将选择和加强现有的教育工具，目的是提高患者对骨关节炎治疗的理解，并增加对现有骨关节炎疗法的使用。此后，该仪器将在一组相对较小的膝盖骨或髋关节骨性关节炎患者中进行试点测试。这一教育工具在提高各种OA疗法的利用率方面的影响将初步确定。

 DESCRIPTION (provided by applicant): Candidate Career Goals: Dr. Ernest R. Vina's long-term career goal is to promote equity for patients with rheumatic and musculoskeletal diseases through the development of interventions to eliminate racial disparities and improve outcomes for patients with these diseases. With his research and clinical experience in addressing the sources of racial disparities in the health and health care of patients with rheumatic diseases, Dr. Vina is well-suited to build a research career in this area. However, he will require additiona training and skills in order to address knowledge gaps by exploring patient characteristics and health beliefs that may contribute to disparities in the medical care of patients with osteoarthrits (OA). Dr. Vina's short-term career goals are 1) to develop the expertise required to study the reasons why race disparities in the use of different types of non-surgical OA treatment exist; and 2) to learn to develop an intervention and implement a clinical trial to reduce racial disparities n the use of various OA treatments. Research Background: OA is a highly prevalent and disabling disease. Racial disparities in the outcomes of OA patients have also been demonstrated, with African-Americans (AAs) carrying a greater burden than whites (WHs). In addition, AAs are also less likely to have history of use of various pharmacologic and non- pharmacologic therapies for OA. Sources of racial healthcare disparities in OA are only partially known. Research Aims: There are two main aims for this K23. The first is to examine the determinants of, and barriers to, the utilization of various OA treatments that contribute to disparities in the care of AAs and WHs. The second is to pilot-test the impact of an intervention designed to improve the utilization of effective, non- surgical OA treatments. Methods: To achieve the goals of the first aim, surveys of patients with knee or hip OA will be conducted. The survey will determine patient demographic information, psychosocial characteristics, disease severity, treatment history and health-related knowledge, beliefs and attitudes. The primary outcomes of interest will include utilization of various treatments, including exercises, topical medications, non-steroidal anti- inflammatory drugs and opioid agents. Hierarchical statistical modeling will be conducted to determine which patient-level variables may mediate racial disparities in the utilization of the various OA treatments. For the second aim, an existing educational tool will be chosen and enhanced with the goal of improving patient understanding of OA treatments and increasing the use of available OA therapies. Thereafter, this instrument will be pilot-tested to a relatively smal group of patients with knee or hip OA. The impact of this educational tool in improving the utilization of various OA therapies will be preliminarily determined.