Mentoring in patient-oriented research in social determinants and atrial fibrillation

口服抗凝剂是心房颤动患者预防卒中的首要指南优先选择。 房颤（AF）是一种常见的疾病，具有较高的社会和医疗成本。健康的社会决定因素（SDOH） 有助于抗凝治疗的可及性和卒中预防所需的长期依从性。这 以病人为导向的指导研究计划将（1）检查个人和邻里的关系， 通过口服抗凝剂平衡社会因素，以及（2）加速创新的卫生服务指导 在SDOH和AF和心血管疾病的计划。SDOH对AF的研究有限， 这里描述的研究将告知SDOH如何导致抗凝治疗的差异。的 调查建立在积极的、受资助的卫生服务研究的核心基础设施之上，并利用这些基础设施 计划，一个大的，区域性的医疗保健系统的资源，以及大的，高度 可概括的行政健康索赔数据。具体的研究目的是：（1）评价 通过覆盖天数比例测量的与抗凝剂依从性相关的社区水平SDOH （PDC）。这一目标将为两项积极招募的临床试验（n=504）增加地理编码，旨在改善 在社会资源有限的个体中坚持抗凝治疗。(2)关联邻域级SDOH 抗凝治疗使用匹兹堡大学医学院的广泛电子健康记录 中心，分析将检查社区水平的SDOH与抗凝处方的关联， AF患者在一个大的，社会异质性的地区。(3)检查SDOH与抗凝剂的关系 处方和1年的依从性在一个大型的管理数据库。我们将采用Optum Clinformatics， 从2015年到2021年，研究个人层面的SDOH与PDC的关系。这些调查将在 一个完善的指导计划的框架，并建立在PI的积极指导能力， 匹兹堡大学医学院和公共卫生学院。辅导活动扩大了 候选人在NHLBI资助的T32培训项目中的作用，匹兹堡大学心脏病学奖学金， 内科住院医师，以及公共卫生学院的博士前和博士后学生。项目（1） 利用大学内由临床赞助的多学科指导机会， 转化科学研究所（CTSI）;（2）加强指导临床试验的开展和设计;以及（3） 扩展和扩大申请人对指导和保留的承诺 来自医学界历史上代表性不足的群体的个人。总而言之，奖励计划将 加强SDOH在心血管疾病中的评价，大规模的卫生服务研究 行政数据，以及强大的学术，研究和临床指导能力。本申请 建议在SDOH和心血管疾病的创新研究以及职业发展活动， 作为以病人为导向的研究的导师，取得了实质性的进展和成就。

Oral anticoagulation is a foremost, guideline-based priority for stroke prevention in individuals with atrial fibrillation (AF), a common condition with high social and medical costs. Social determinants of health (SDOH) contribute to accessibility of anticoagulation and the long-term adherence necessary for stroke prevention. This patient-oriented mentoring research program will (1) examine the relations of individual- and neighborhood- level social factors with oral anticoagulation, and (2) accelerate an innovative health services mentoring program in SDOH and AF and cardiovascular disease. SDOH have had limited investigation in AF, such that the investigations described here will inform how SDOH contribute to disparities in anticoagulation. The investigations build on and leverage the core infrastructure of an active, funded health services research program, the resources of a large, regional health care system, and the availability of large, highly generalizable administrative health claims data. The specific investigatory aims are: (1) Evaluate neighborhood-level SDOH in relation to anticoagulant adherence as measured by proportion of days covered (PDC). This aim will add geocoding to two actively recruiting clinical trials (n=504) which aim to improve adherence to anticoagulation in individuals with limited social resources. (2) Relate neighborhood-level SDOH to anticoagulation. Employing the extensive electronic health record of the University of Pittsburgh Medical Center, the analysis will examine associations of neighborhood-level SDOH with anticoagulation prescribing in individuals with AF in a large, socially heterogeneous region. (3) Examine SDOH in relation to anticoagulant prescription and 1-year adherence in a large administrative database. We will employ Optum Clinformatics to examine individual-level SDOH in relation to PDC from 2015-2021. These investigations will be conducted in the framework of a well-established mentoring program and build on the PI's active mentoring capacity in the Schools of Medicine and Public Health at the University of Pittsburgh. Mentoring activities expand the candidate's role with NHLBI-funded T32 training programs, the University of Pittsburgh cardiology fellowship, internal medicine residency, and pre- and post-doctoral students in the School of Public Health. The project (1) leverages multidisciplinary mentoring opportunities within the University sponsored by the Clinical and Translational Science Institute (CTSI); (2) bolsters mentorship in conduct and design of clinical trials; and (3) extends and broadens the applicant's demonstrated commitment towards mentoring and retention of individuals from groups historically underrepresented in medicine. In summary, the award program will enhance evaluation of SDOH in cardiovascular disease, health services research with large-sized administrative data, and capacities for robust academic, research, and clinical mentoring. This application proposes innovative research in SDOH and cardiovascular disease alongside career development activities for substantive progress and achievement as a mentor in patient-oriented research.