Promoting Diversity and Sustainability in the NIDDK-Supported Research Workforce through Mentoring Early Career Investigators: Focus on Health Equity

通过指导早期职业研究人员促进 NIDDK 支持的研究队伍的多样性和可持续性：关注健康公平

• 批准号: 10797832
• 负责人: Sandra Amaral
• 金额: $ 11.96万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10797832
• 关键词: Address; Advocacy; Algorithms; Award; Black Populations; Childhood; Communities; Data; Data Collection; Data Sources; Dialysis procedure; Disparity; Donor Selection; Education; Educational Curriculum; Electronic Health Record; Eligibility Determination; End stage renal failure; Equity; Ethnic Origin; Evaluation; Face; Faculty; Goals; Health Disparities Research; Health Insurance; Healthcare Systems; Hispanic Populations; Home visitation; Inequity; Information Systems; Infrastructure; Institutional Racism; Insurance Coverage; Internships; Intervention; Interview; Kidney; Kidney Transplantation; Knowledge; Leadership; Life; Link; Living Donors; Master of Science; Mentors; National Institute of Diabetes and Digestive and Kidney Diseases; Neighborhoods; Nephrology; Not Hispanic or Latino; Outcome; Patients; Pediatrics; Policies; Positioning Attribute; Poverty; Process; Publishing; Race; Registries; Renal Replacement Therapy; Renal function; Research; Research Design; Research Methodology; Research Personnel; Research Proposals; Research Support; Residencies; Role; Surveys; Time; Training; Translations; Transplant Recipients; Transplantation; Underrepresented Minority; Underserved Population; United States; Waiting Lists; Work; career; career development; cohort; community based participatory research; disparity reduction; ethnic disparity; follow-up; health disparity; health equity; health inequalities; implementation science; improved; individual patient; marginalized population; method development; minority investigator; national surveillance; programs; racial bias; racial disparity; skills; social; social health determinants; sound; theories; tool; training opportunity; transplant registry

Project Summary/Abstract The broad, long-term objectives of this proposal are two-fold: 1) to provide high-quality mentoring to contribute to the career development of trainees from diverse backgrounds and 2) to advance the quality, rigor and breadth of health equity research in transplantation and pediatric nephrology. For decades, it has been recognized that Blacks and Hispanics are less likely to receive kidney transplantation compared with non-Hispanic whites (NHWs), especially from a living donor. Most published disparities studies have used race/ethnicity as a social construct and attributed differences in transplant access and outcomes to social determinants of health (SDOH). Yet, assessments of SDOH are often limited to race/ethnicity, health insurance status and neighborhood poverty level, and most studies are descriptive with few providing actionable findings to mitigate inequities. Further, proposed interventions are often targeted at the individual patient rather than the healthcare systems that perpetuate systemic racial bias. Another challenge in achieving equity in transplant access lies in the limits of national data. Currently, national surveillance registries capture patients when they begin renal replacement therapy (United States Renal Data System) and when they are waitlisted or transplanted (Scientific Registry of Transplant Recipients), but not what happens during the time in between when patients must undergo transplant referral and evaluation to be deemed transplant eligible. Given this context, the transplant community has asserted a call to action to achieve equity in transplantation by improving rigor, quality and transparency in transplant-related health equity research. Dr. Amaral’s research proposal seeks to move from describing disparities to achieving equity in transplant access and outcomes through research that leverages diverse study designs and varied data sources to identify potentially modifiable healthcare system barriers to transplant access. Two current projects will support this award. The REACH-TRANSPLANT study (R01 DK120886) examines racial/ethnic inequities that arise during recipient and living donor (LD) evaluation, LD selection, and LD follow-up. The study has three aims and applies both primary and secondary data collection, large electronic health records, research cohort data and survey data. The second project, The House Calls Project, focuses on identifying and addressing adverse social determinants of health (SDOH) that interfere with pediatric kidney transplant evaluation completion. This study will use interview and survey data. These studies provide robust training opportunities in health equity research for Dr. Amaral as a mentor and for mentees across many levels and background, making this proposal ideally aligned with the overarching goals of the K26 award mechanism.

项目概要/摘要 该提案的广泛、长期目标有两个：1）提供高质量的指导以做出贡献 2) 提高质量、严谨性和 移植和儿科肾病学领域健康公平研究的广度。 几十年来，人们已经认识到黑人和西班牙裔接受肾移植的可能性较小 与非西班牙裔白人 (NHW) 相比，尤其是来自活体捐赠者。大多数发表的差异研究 将种族/民族作为一种社会结构，并将移植机会和结果的差异归因于 健康的社会决定因素（SDOH）。然而，SDOH 的评估通常仅限于种族/民族、健康状况 保险状况和社区贫困水平，大多数研究都是描述性的，很少提供 减少不平等现象的可行调查结果。此外，拟议的干预措施通常针对个人 患者而不是使系统性种族偏见长期存在的医疗保健系统。实现目标的另一个挑战 移植获得的公平性取决于国家数据的限制。目前，国家监测登记处捕获 患者何时开始肾脏替代治疗（美国肾脏数据系统）以及何时 列入候补名单或已移植（移植受者的科学登记处），但不是在此期间发生的情况 患者必须接受移植转诊和评估才能被视为适合移植的时间之间。 鉴于此，移植界呼吁采取行动，实现移植公平 通过提高移植相关健康公平研究的严谨性、质量和透明度。阿马拉尔博士的研究 该提案旨在从描述差异转向实现移植机会和结果的公平 通过利用不同的研究设计和不同的数据源的研究来识别潜在的 可改变的医疗保健系统阻碍移植的障碍。当前的两个项目将支持该奖项。这 REACH-TRANSPLANT 研究 (R01 DK120886) 检查接受者和接受者期间出现的种族/民族不平等 活体捐献者 (LD) 评估、LD 选择和 LD 随访。该研究有三个目标并同时适用 主要和次要数据收集、大型电子健康记录、研究队列数据和调查数据。 第二个项目是“上门服务项目”，重点是识别和解决不利的社会问题 干扰儿科肾移植评估完成的健康决定因素（SDOH）。这项研究 将使用访谈和调查数据。这些研究为健康公平研究提供了强有力的培训机会 对于作为导师的阿马拉尔博士以及来自不同级别和背景的受训者来说，使该提案成为理想的选择 与 K26 奖励机制的总体目标保持一致。