Racial Disparity in the Utilization of Joint Replacement for Osteoarthritis

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DESCRIPTION (provided by applicant): Dr. Said Ibrahim, a Professor of Medicine at Penn and Co-Director of the VA National Center for Health Equity Research and Promotion (CHERP), seeks the extension of the K24 Mid-Career Investigator Award in Patient-Oriented Research to continue this fruitful research program while dedicating significant time for mentoring the next generation of medical students, residents, clinical and post-doctoral fellows, and junior faculty trainees, particularly under-represented minorities, in his field of research. Despite nearly 25 years of national initiatives to improve the quality and equity of health and health care for vulnerable populations, the 2011 AHRQ National Healthcare and Disparities Report concluded that health care quality and access remain suboptimal, especially for minority and low-income groups. A recent economic analysis demonstrated that the direct and indirect costs of health inequalities and premature death were $1.24 trillion between 2003 and2006. Thus, health equity research directly addresses an unrelenting health care problem with overwhelming public health and economic consequences for our nation. Dr. Ibrahim leads a well-established research program on racial disparities in utilization of joint replacement in the management of end-stage osteoarthritis (OA). His work on understanding and intervening on racial disparity in access and utilization of joint replacement in the management of knee/hip OA provides a national model for advancing health disparities research from first- generation studies that detected disparities in care to second-generation studies exploring the reasons for these disparities to the first-ever third-generation intervention trials to reduce this well-documented disparity. The absence of mentors and role models is an important barrier to career advancement and is often the cause of attrition, particularly among women and minority faculty. Women and underrepresented minorities report greater difficulty finding established mentors with the protected time and effort to mentor. This has led to the call for more effective, constructive nurturing of minority faculty mentors and emphasis on promoting their careers in academic medicine. This candidate has a track record of mentoring underrepresented trainees and those who are interested in health equity research careers. Over the course of this award, the candidate will devote 45-50% effort each year to mentoring. Starting with 6 mentees in Year one, he will add 4 new mentees each subsequent year. The candidate will mentor approximately 5 students and/or residents, 5 fellows, and 8 junior faculty members in patient-oriented research in the course of this award. Therefore, the specific aims of the proposed K24 renewal application are: 1) To continue and advance a trajectory of research to understand and intervene on racial disparity in the management of end-stage knee/hip OA and access to joint replacement; 2) To provide mentoring for the future generation of patient-oriented health equity investigators; and 3) To continue Dr, Ibrahim's leadership role in national and institutional efforts to diversify the U.S. health care research workforce.