Racial Disparities in the Treatment of Psoriasis: A Mixed Methods Approach

银屑病治疗中的种族差异：混合方法

• 批准号: 8948010
• 负责人: Junko Takeshita
• 金额: $ 13.31万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8948010
• 关键词: Address; Affect; African American; Age; Area; Attitude; Award; Biological Response Modifier Therapy; Cardiovascular system; Caring; Caucasians; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Chronic; Clinic; Clinical; Clinical Treatment; Cohort Studies; Data; Data Files; Data Set; Dermatologic; Dermatology; Disease; Doctor of Philosophy; Economic Burden; Emotional; Event; Federally Qualified Health Center; Feeling; Foundations; Future; General Population; Goals; Health; Healthcare; Inflammatory; Interview; Medicare; Medicare claim; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Minority; Oral; Outcome; Outpatients; Patients; Pennsylvania; Perception; Pharmaceutical Preparations; Phototherapy; Physicians; Population; Postdoctoral Fellow; Psoriasis; Public Health; Qualitative Research; Race; Research; Research Methodology; Research Personnel; Research Priority; Risk; Risk Factors; Socioeconomic Status; Structure; Sum; Systemic Therapy; Thinking; Training; Treatment Effectiveness; Universities; beneficiary; career; clinical practice; cost; experience; health economics; health inequalities; health related quality of life; improved; innovation; instructor; patient oriented; patient oriented research; premature; public health relevance; racial disparity; skin disorder

 DESCRIPTION (provided by applicant): The overall objective of this K23 award proposal is to provide support for the additional training and experience necessary for the candidate, Junko Takeshita, MD, PhD, to transition from recent post-doctoral trainee and current Instructor in Dermatology to an independent patient-oriented investigator with a focus on health and healthcare disparities in psoriasis. Specifically, the aims of this proposal are to identify, defin, and understand disparities between African American and Caucasian Medicare beneficiaries in the treatment of psoriasis. We hypothesize that: 1) initiation of specific psoriasis therapies and persistence on therapies are different between African American and Caucasian patients with psoriasis, and 2) there are important differences in patient-level factors such as perceptions of psoriasis and attitudes towards treatments between the two racial groups that contribute to differential treatment of psoriasis. As clinicians are currently unaware of existing disparities in psoriasis treatment, we seek to shift current clinical practice paradigms with this proposal by newly identifying and establishing an understanding of racial disparities in the treatment of psoriasis with the goal of reducing any identified disparities and ultimately improving treatment and clinical outcomes, particularly among African American patients with psoriasis. A sequential mixed methods approach will be utilized to address the proposed aims: i) first, a quantitative longitudinal cohort study using Medicare data will be performed in order to compare initiation of therapies and persistence on therapies between African American and Caucasian Medicare beneficiaries with psoriasis; and ii) second, a qualitative study, informed by results from the quantitative study, will be performed using semi-structured interviews and freelists in order to identify patient- level determinants of the identified psoriasis treatment disparities between African Americans and Caucasians. In order to achieve these goals, the candidate will need training in three critical areas: 1) use of Medicare claims data; 2) disparities research methods; and 3) qualitative and mixed methods research. The candidate's training plan, which includes a combination of didactic coursework, practical experience through the completion of her proposed research, and directed mentorship from her expert mentoring team over the five year award period, will enable her to launch a successful career as an independent investigator in patient-oriented research and make important contributions to the field of dermatology via the study of disparities in the care of psoriasis.

 描述（由申请人提供）：本 K23 奖项提案的总体目标是为候选人 Junko Takeshita（医学博士、博士）提供必要的额外培训和经验支持，以从最近的博士后实习生和现任皮肤病学讲师过渡到以患者为中心的独立研究者，重点关注银屑病的健康和医疗保健差异。具体来说，该提案的目的是确定、定义和理解非裔美国人和白人医疗保险受益人在牛皮癣治疗方面的差异。我们假设：1）非洲裔美国人和白人银屑病患者之间特定银屑病治疗的开始和持续治疗是不同的，2）患者层面的因素存在重要差异，例如两个种族群体之间对银屑病的看法和对治疗的态度，这有助于银屑病的差异化治疗。由于临床医生目前并没有意识到现有的差异 银屑病治疗，我们寻求通过这一提案改变当前的临床实践范式，通过新确定和建立对银屑病治疗中种族差异的理解，目标是减少任何已确定的差异，并最终改善治疗和临床结果，特别是在非裔美国银屑病患者中。将采用序贯混合方法来实现拟议的目标：i）首先，将使用医疗保险数据进行定量纵向队列研究，以比较患有银屑病的非裔美国人和白人医疗保险受益人之间的治疗开始和持续治疗； ii) 其次，将使用半结构化访谈和自由列表进行定性研究，以定量研究的结果为基础，以确定非裔美国人和白种人之间银屑病治疗差异的患者水平决定因素。为了实现这些目标，候选人将需要在三个关键领域进行培训：1）医疗保险索赔数据的使用； 2）差异研究方法； 3）定性和混合方法研究。候选人的培训计划包括教学课程、完成其拟议研究的实践经验以及专家指导团队在五年奖励期内的指导指导，将使她能够作为以患者为导向的研究的独立研究者开启成功的职业生涯，并通过研究银屑病护理的差异为皮肤病学领域做出重要贡献。