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

点击翻译按钮获取中文摘要

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.