Engaging Communities and Institutions to Reduce Health Disparities in Cleveland

克利夫兰的特点是极高的贫困率，相当数量的种族/少数民族，以及明显的健康差距。我们建议让克利夫兰的医疗保健提供者、教育机构、社区组织和政府机构参与，以了解和减少健康差距。为了利用现有社区和机构的优势，我们将首先关注三种相互关联的典型疾病：高血压、肾脏疾病和移植。这些疾病影响了许多人，并具有一些在美国观察到的最显著的健康差距。 研究核心包括的项目包括：(A)利用非专业健康顾问帮助患者解决阻碍高血压治疗的社会背景因素；(B)利用口译员为讲西班牙语的高血压或肾脏疾病患者代言；(C)利用移植受者作为导航员，改善肾脏移植的机会。研究培训/教育核心包括：(A)招收学生，特别是少数族裔背景的学生，参加与健康差距有关的本科生、研究生和博士后课程；(B)提供与健康差距研究相关的各种教育机会；(C)支持博士后学生和初级教师，特别是来自代表性不足的群体，以确保成功进入学术职位。社区参与/外联核心包括以社区为基础的视频干预，以加强器官捐赠者卡的签署。行政核心将协调和促进项目/核心之间的互动，提供共享的资源和人员，协助其他社区努力解决差异，领导与其他NCMHD英才研究中心的互动，传播研究成果，并制定未来的倡议。 三个研究项目中的每一个以及社区参与/外联核心都侧重于测试干预措施，以减少健康差距。此外，这些干预措施的设计是基于对在每个研究地区造成健康差距的机制的理解。我们的申请的其他优势和创新特点包括通过全社会范围的方法选择项目，强有力的机构承诺，以及研究团队的经验和承诺。此外，拟议项目的设计不仅是为了解决健康差距的一个重要方面，而且也是为了为未来更大规模的努力奠定基础。由于实施这些项目而建立的社区和机构基础设施将用于今后针对更广泛条件的努力。

Cleveland is characterized by an extremely high poverty rate, substantial numbers of racial/ethnic minorities, and marked health disparities. We propose to engage Cleveland's health care providers, educational institutions, community organizations, and government agencies to understand and reduce health disparities. To take advantage of pre-existing community and institutional strengths, we will focus initially on 3 interrelated prototypical conditions: hypertension, kidney disease, and transplantation. These conditions affect many individuals and have some of the most striking health disparities observed in the United States. The Research Core includes projects that involve (a) utilizing lay health advisors to help patients address the social contextual factors that act as barriers to hypertension management, (b) utilizing interpreters as advocates for Spanish speaking patients with hypertension or kidney disease, and (c) utilizing transplant recipients as navigators to improve access to kidney transplantation. The Research Training/Education Core involves (a) recruiting students, particularly from minority backgrounds, into undergraduate, graduate, and postdoctoral programs related to health disparities, (b) providing diverse educational opportunities relevant to health disparities research, and (c) supporting postdoctoral students and junior faculty, particularly from underrepresented groups, to ensure successful entry into academic positions. The Community Engagement/Outreach Core involves a community-based video intervention to enhance signing of organ donor cards. The Administrative Core will coordinate and foster interactions across projects/cores, provide shared resources and personnel, assist in other community efforts to address disparities, lead interactions with other NCMHD Research Centers of Excellence, disseminate findings, and develop future initiatives. Each of the three research projects as well as the Community Engagement/Outreach Core focus on testing interventions to reduce health disparities. Moreover, the design of these interventions is informed by an understanding of the mechanisms that created health disparities in each of the areas studied. Other strengths and innovative features of our application include selection of projects through a community-wide approach, a strong institutional commitment, and the experience and commitment of the study team. In addition, the proposed projects have been designed not only to address an important aspect of health disparities but also to set the stage for future larger scale efforts. The community and institutional infrastructure established as a result of conducting these projects will be used in future efforts that target a broader range of conditions.