Patient-Centered Anticoagulation Self-Monitoring in Minority Patients.

描述(申请人提供)：抗凝患者自我监测的采用主要限于非少数民族和社会经济地位较高的个人。影响采用自我监测抗凝治疗的因素尚未得到系统研究。了解这些因素对服务不足的少数族裔患者尤其重要，他们获得高质量护理和抗凝相关并发症的风险最高。候选人的长期目标是发展一个成功的职业生涯，成为一名独立的比较有效性研究人员，专注于以患者为中心的技术干预，支持慢性病患者方便、可获得和具有成本效益的护理模式。这个K23应用程序的目标是 了解影响少数民族患者接受抗凝自我监测的因素及可行性，完善以患者为中心的教育干预措施。中心假设是，对少数族裔患者的患者自我监测加上以患者为中心的教育干预，将产生与基于专门抗凝诊所监测的抗凝控制质量相当的抗凝控制。拟议研究的基本原理是，少数族裔人群发生并发症的风险最高，建立有效的自我护理模式是降低这些人群中抗凝控制不良导致的并发症风险的第一个关键步骤。在初步数据的指导下，本建议的研究目标将通过追求三个具体目标来实现：1)确定影响少数群体采用抗凝自我监测的患者和提供者因素。2)调整和改进教育干预措施，既解决已确定的障碍，又强调已确定的对抗凝自我监测的积极影响。3)论证少数民族人群抗凝自我监测与教育干预相结合的可行性和有效性。这种方法是创新的，因为它与标准的基于自我测试技能的干预措施不同，它针对的是需要有效和方便的选择来管理潜在威胁生命的疾病的弱势、高风险人群。这项拟议的研究意义重大，因为它是减少高危患者获得和采用有效自我护理模式的健康差距的第一步。为了实现概述的研究目标，Nutescu博士制定了一项职业发展计划，重点是指导和教学相结合，以提高她在定性方法、健康行为研究、临床试验设计以及解决跨文化和健康差异研究的方法学问题方面的技能。纳特斯库博士的研究和职业发展计划将主要在芝加哥的伊利诺伊大学进行。她的经验丰富的指导团队包括高素质、资金充足的独立调查人员，他们对纳特斯库博士的职业潜力和研究提案充满热情。

DESCRIPTION (provided by applicant): The adoption of anticoagulation patient self-monitoring has been limited primarily to non-minority and higher socioeconomic individuals. Factors influencing the adoption of self-monitoring of anticoagulation have not been systematically examined. Understanding these factors is especially important in minority underserved patients who are at highest risk for accessing high-quality care and of anticoagulation related complications. The long term goal of the candidate is to develop a successful career as an independent comparative-effectiveness re- searcher with a focus in technology-based patient-centered interventions that support convenient, accessible, and cost-effective models of care in patients with chronic illness. The objective in this K23 application is to identify factors influencing adoption and feasibility of anticoagulation self-monitoring in minority patients and refine a patient-centered educational intervention. The central hypothesis is that patient self-monitoring coupled with a patient-centered educational intervention for minority patients will result in anticoagulation control of comparable quality to that seen in specialized anticoagulation clinic-based monitoring The rationale for the proposed research is that minority populations are at highest risk of complications and creating a model of effective self-care is the first critical step in reducing the risk of complications resulting from poor anticoagulation control in these populations. Guided by preliminary data, the research objective of this proposal will be accomplished by pursuing three specific aims: 1) Identify patient and provider factors that influence adoption of anti- coagulation self-monitoring in a minority population. 2) Adapt and refine an education intervention that both addresses identified barriers and emphasizes identified positive influences to anticoagulation self-monitoring. 3) Demonstrate the feasibility and effectiveness of anticoagulation self-monitoring coupled with the educational intervention in a minority population. The approach is innovative, because it is a departure from the standard self-testing skill-based interventions, and it targets a disadvantaged, high-risk population in need of effective and convenient options to manage a potentially life threatening condition. The proposed research is significant, because it is the first step towards a reduction of health disparities for access to and adoption of effective models of self-care in high risk patients. To achieve the outlined research goals, Dr. Nutescu has developed a career development plan that focuses on a combination of mentoring and didactics to enhance her skills in qualitative methods, health behavior research, clinical trial design, and methodological issues addressing cross- cultural and health disparities research. Dr. Nutescu's research and career development plans will take place predominantly at the University of Illinois at Chicago. Her experienced mentoring team includes highly qualified, well funded independent investigators who are dedicated and enthusiastic about Dr. Nutescu's career potential and research proposal.