Development and Implementation of Optimal Rehabilitation Care Pathways to Reduce Disparities in Rehabilitation Outcomes after Joint Replacement

项目概要/摘要 这个NIMHD指导研究科学家职业发展奖（K23）博士。 Allyn Bove是匹兹堡大学物理治疗学院的助理教授， 健康和康复科学，将建立博士博夫作为一个独立的健康公平 具有肌肉骨骼康复和使用 实施科学的方法来尝试减少差距的战略。拟议 研究与NIMHD的几个与临床和健康相关的研究兴趣一致 服务研究。这个多层次的卫生服务研究项目符合NIMHD的目标， 采取“多层次干预措施”，寻求“增加健康公平”和“改善获得或 受健康差距影响的人口的护理质量”。这也符合NIMHD的追求 研究以了解采用和遵守《公约》的障碍和促进因素， 在卫生保健环境中的循证实践和干预措施”。 这项为期四年的K23奖项将分三个阶段进行。上 目的是，我们将与提供者和患者合作伙伴合作，以确定障碍和促进因素， 实施最佳的关节成形术后康复护理途径， 结果和缓解基于患者种族和收入/保险的结果差异 status.在第二阶段，我们将联合收割机的初步数据与目标1的信息相结合， 制定基于证据的方法，以公平地实施最佳康复护理 减少社区康复和身体功能差距的途径 关节成形术在最后一步，我们将试点测试这些循证创新的实施， 康复护理路径。这项工作很重要，因为它将促进康复 差异研究不仅仅是简单地识别差异， 新的干预措施，以减少差异和改善病人的结果。 拟议的工作借鉴了Bove博士先前对健康差异的研究， 研究方法，以及骨关节炎和关节成形术患者的康复。 这项工作将扩展博士Bove的工作到多层次的开发和实施 采取干预措施，解决这一人群的健康差距。在拟议的 研究，正式培训和指导概述了这个K23应用程序，博士博夫将很好- 定位为寻求R 01资金的大型混合有效性/实施试验，这些 旨在最大限度地发挥功能并促进髋关节置换术后结局公平的护理途径 和膝关节置换手术。

PROJECT SUMMARY/ABSTRACT This NIMHD Mentored Research Scientist Career Development Award (K23) for Dr. Allyn Bove, an Assistant Professor of Physical Therapy at the University of Pittsburgh School of Health and Rehabilitation Sciences, will establish Dr. Bove as an independent health equity investigator with expertise in health disparities in musculoskeletal rehabilitation and use of implementation science methods to trial strategies to mitigate disparities. The proposed research aligns with several of NIMHD’s research interests related to clinical and health services research. This multi-level health services research project aligns with NIMHD’s goals to pursue “multilevel interventions” that seek to “increase health equity” and “improve access to or quality of care for populations affected by health disparities”. It also aligns with NIMHD’s pursuit of “research to understand barriers and facilitators to the adoption of and adherence to evidence-based practices and interventions in healthcare settings”. The research proposed in this four-year K23 award will occur in three phases. In the first aim, we will engage with provider and patient partners to identify barriers and facilitators to implementing optimal post-arthroplasty rehabilitation care pathways designed to improve outcomes and mitigate outcomes disparities based on patient race and income/insurance status. In the second stage, we will combine our preliminary data with information from Aim 1 to develop an evidence-based approach for equitable implementation of optimal rehabilitation care pathways to reduce disparities in community-based rehabilitation and physical function after arthroplasty. In the final step, we will pilot test implementation of these evidence-based novel rehabilitation care pathways. This work is important because it will progress rehabilitation disparities research beyond simply identifying differences toward designing and implementing novel interventions to reduce disparities and improve patient outcomes. The proposed work draws on Dr. Bove’s prior research on health disparities, qualitative research methodology, and rehabilitation for individuals with osteoarthritis and joint arthroplasty. This work will extend Dr. Bove’s work into the development and implementation of multi-level interventions to address health disparities in this population. Upon conclusion of the proposed research, formal training and mentorship outlined in this K23 application, Dr. Bove will be well- positioned to seek R01 funding for a large hybrid effectiveness/implementation trial of these care pathways that are designed to maximize function and promote equity in outcomes after hip and knee arthroplasty surgery.