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

指导以患者为中心的社会决定因素和心房颤动研究

• 批准号: 10687127
• 负责人: Jared W. Magnani
• 金额: $ 12.08万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-19 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10687127
• 关键词: Acceleration; Achievement; Address; Adherence; Affect; Anticoagulants; Anticoagulation; Area; Atrial Fibrillation; Award; Cardiology; Cardiovascular Diseases; Censuses; Cessation of life; Clinical; Clinical Investigator; Clinical Sciences; Clinical Trials Design; Communities; Complement; Data; Databases; Dementia; Diagnosis; Disparity; Education; Electronic Health Record; Ethnic Origin; Evaluation; Fellowship; Fostering; Funding; Geographic Information Systems; Guidelines; Health; Health Services; Health Services Research; Healthcare Systems; Heart failure; Home; Household; Income; Individual; Individual Adjustment; Infrastructure; Inpatients; Internal Medicine; Intervention; Investigation; Ischemic Stroke; K-Series Research Career Programs; Literature; Measures; Mediation; Medical Care Costs; Medical center; Medicine; Mentors; Mentorship; Morbidity - disease rate; Myocardial Infarction; National Heart, Lung, and Blood Institute; Neighborhoods; Occupations; Oral; Outcome; Outpatients; Ownership; Participant; Pathway interactions; Patients; Pennsylvania; Pharmaceutical Preparations; Postdoctoral Fellow; Public Health; Public Health Schools; Race; Recruitment Activity; Reporting; Research; Residencies; Resources; Risk; Role; Rural; Stroke prevention; Training; Training Programs; Translational Research; Universities; Visit; Vocation; Warfarin; administrative database; career development; clinical trial recruitment; deprivation; disparity reduction; doctoral student; health equity; improved; innovation; medical schools; metropolitan; multidisciplinary; neighborhood association; novel; patient oriented; patient oriented research; pre-doctoral; prevent; programs; prospective; randomized, clinical trials; residence; rurality; secondary analysis; segregation; social; social determinants; social disparities; social factors; social health determinants; success; thromboembolic stroke; treatment and outcome

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.

口服抗凝是预防房颤患者卒中的首要指南 纤颤(AF)，一种常见的疾病，具有很高的社会和医疗成本。健康的社会决定因素(SDOH) 有助于获得抗凝药物和预防中风所需的长期坚持。这 以病人为导向的辅导研究计划将(1)检查个人和邻里之间的关系 用口服抗凝剂拉平社会因素；(2)加快创新健康服务辅导 SDOH、房颤和心血管疾病方面的计划。SDOH在房颤方面调查有限，以至于 这里描述的研究将告诉我们SDOH是如何导致抗凝差异的。这个 调查建立在积极的、有资金支持的卫生服务研究的核心基础设施的基础上并加以利用 计划，大型地区性医疗保健系统的资源，以及大规模、高度可用的 可概括的行政健康索赔数据。具体的调查目的是：(1)评价 邻区水平SDOH与抗凝剂粘附性的关系，以覆盖天数的比例衡量 (PDC)。这一目标将把地理编码添加到两个积极招募的临床试验(n=504)中，旨在改进 在社会资源有限的个人中坚持抗凝。(2)关联邻域级SDOH 去抗凝。使用匹兹堡医科大学广泛的电子健康记录 中心，这项分析将检查邻区水平的SDOH与抗凝处方的关系 在一个巨大的社会异质性地区的房颤患者。(3)检查SDOH与抗凝剂的关系 在大型管理数据库中提供处方和一年的坚持。我们将采用Optom Clinformatics来 检查2015-2021年个人层面SDOH与PDC的关系。这些调查将在#年进行 建立完善的辅导计划框架，并建立在PI在 匹兹堡大学医学院和公共卫生学院。指导活动扩展了 应聘者在NHLBI资助的T32培训项目中的角色，匹兹堡大学心脏病学奖学金， 内科住院医师，公共卫生学院博士后和博士后。项目(1) 利用大学内由临床和医学中心赞助的多学科指导机会 翻译科学研究所(CTSI)；(2)在临床试验的进行和设计方面加强指导；以及(3) 扩展和扩大申请者对指导和保留 来自历史上在医学界代表性不足的群体的个人。总而言之，该奖项计划将 加强SDOH在心血管疾病、卫生服务研究中的大型应用 管理数据，以及强大的学术、研究和临床指导能力。此应用程序 建议在SDOH和心血管疾病方面进行创新研究，同时开展职业发展活动 在以患者为中心的研究中作为导师取得的实质性进展和成就。

项目成果

Association of Race and Ethnicity on the Management of Acute Non-ST-Segment Elevation Myocardial Infarction.

• DOI: 10.1161/jaha.121.025758
• 发表时间: 2022-06-21
• 期刊: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• 影响因子: 5.4
• 作者: Tertulien, Tarryn;Broughton, Stephen T.;Swabe, Gretchen;Essien, Utibe R.;Magnani, Jared W.
• 通讯作者: Magnani, Jared W.

Impact of Neighborhood on Cardiovascular Health: A Contemporary Narrative Review.

社区对心血管健康的影响：当代叙事回顾。

• DOI: 10.1007/s11886-023-01919-1
• 发表时间: 2023
• 期刊: Current cardiology reports
• 影响因子: 3.7
• 作者: Fullin,Kerianne;Keen,Susan;Harris,Kathryn;Magnani,JaredW
• 通讯作者: Magnani,JaredW

Association of Depression and Adherence to Oral Anticoagulation in Patients With Atrial Fibrillation.

• DOI: 10.1161/jaha.123.031281
• 发表时间: 2023-11-20
• 期刊: Journal of the American Heart Association
• 影响因子: 5.4

Stressful Life Events, Social Support, and Incident Breast Cancer by Estrogen Receptor Status.

• DOI: 10.1158/1940-6207.capr-22-0472
• 发表时间: 2023-05-01
• 期刊: Cancer prevention research (Philadelphia, Pa.)

Leaving the Social Vacuum: Expanding Cardiovascular Guidelines to Embrace Equity.

离开社会真空：扩大心血管指南以拥抱公平。

• DOI: 10.1161/circulationaha.122.060881
• 发表时间: 2022-07-19
• 期刊: Circulation
• 影响因子: 37.8
• 作者: Magnani JW;Brewer LC
• 通讯作者: Brewer LC