Improving the Quality of Heart Failure Care for American Indian Patients Receiving Care through the Indian Health Service

提高通过印第安人卫生服务中心接受护理的美洲印第安人患者的心力衰竭护理质量

• 批准号: 10738653
• 负责人: Lauren A Eberly
• 金额: $ 18.46万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-12 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738653
• 关键词: Address; Advisory Committees; Africa South of the Sahara; Alaska Native; American Indians; Award; Behavior; Cardiovascular Diseases; Cardiovascular system; Caring; Characteristics; Chronic Disease; Clinical; Collaborations; Coronary heart disease; Data; Data Sources; Databases; Devices; Disparity; EFRAC; Ensure; Equity; Face; Familiarity; Funding; Future; General Population; Goals; Guidelines; Health Personnel; Health Priorities; Health Services; Heart failure; Hospitalization; Incidence; Inequity; Institution; Interview; Literature; Maps; Medical; Mentors; Mentorship; Methodology; Modeling; Morbidity - disease rate; Native-Born; Navajo; Outcome; Patient Discharge; Patients; Pharmaceutical Preparations; Pharmaceutical Services; Population; Pragmatic clinical trial; Provider; Public Health; Publishing; Qualitative Research; Quality of Care; Race; Recommendation; Research; Research Methodology; Research Personnel; Research Priority; Research Training; Resources; Rural; Service delivery model; Site; Specialist; Structure; System; Testing; Therapeutic; Time; Training; Tribes; United States; United States Indian Health Service; United States National Institutes of Health; Variant; Vulnerable Populations; Work; access disparities; burden of illness; cardiovascular health; care delivery; career; clinical database; clinical training; combat; cost; effectiveness evaluation; evidence base; health care availability; health disparity; high risk; implementation science; implementation strategy; improved; innovation; marginalization; marginalized population; mortality; patient oriented; racial minority; racial population; service providers; study population; theories; trend; uptake

PROJECT SUMMARY/ABSTRACT Heart failure morbidity and mortality disproportionately impact racial minorities, and inequitable care delivery based on race is pervasive in the United States. While the American Indian/Alaska Native population is one of the populations that suffers most from health disparities, little is known about their burden of cardiovascular disease, particularly heart failure. In fact, there are no studies in the current era evaluating the burden and outcomes of heart failure among the American Indian/Alaska Native population, or the quality of care they receive. The proposed mixed-methods research plan aims to characterize the burden of disease, outcomes, and quality of care of American Indian/Alaska Native patients with heart failure with reduced ejection fraction receiving care through the Indian Health Service— the principal health care provider for the American Indian/Alaska Native population, as well as to determine implementation strategies to ensure quality heart failure care for this population. Aim 1 seeks to characterize the clinical characteristics, as well as rates of guideline directed medical and device therapy and outcomes of American Indian/Alaska Native patients with heart failure receiving care through the Indian Health Service. This aim will utilize a large administrative clinical and claims database. Aim 2 will augment this analyses by employing qualitative research methods to interview American Indian heart failure patients discharged after a heart failure hospitalization, as well as primary providers at two Indian Health Service sites in Navajo Nation to better understand barriers to quality heart failure care. Aim 3 will employ an implementation mapping approach with a stakeholder taskforce at the same sites to determine the highest priority strategies to improve heart failure care for this population. These aims will lead to a future pilot pragmatic clinical trial of American Indians with heart failure in Navajo Nation, which will be used to evaluate the effectiveness of the highest priority strategies to improve care identified in aim 3. These research aims are part of a comprehensive training plan and will be supervised by a mentorship and advisory team consisting of national leaders in health services and implementation science research, and advanced statistical and qualitative methodologies, and will guide my transition to an independently funded research career.

项目摘要/摘要 心力衰竭发病率和死亡率对少数民族的影响不成比例，以及不公平的护理提供 基于种族的歧视在美国很普遍虽然美国印第安人/阿拉斯加原住民人口是 受健康差异影响最大的人群，对他们的心血管疾病负担知之甚少。 疾病，特别是心脏衰竭。事实上，目前还没有研究评估负担， 美国印第安人/阿拉斯加原住民心力衰竭的结果，或他们的护理质量， 接收。拟议的混合方法研究计划旨在描述疾病负担、结果， 射血分数降低的美国印第安人/阿拉斯加原住民心力衰竭患者的护理质量 通过印度卫生服务接受护理-美国人的主要卫生保健提供者 印第安人/阿拉斯加原住民，以及确定确保心脏质量的实施策略 对这一人群的关怀。目的1旨在描述临床特征，以及 美国印第安人/阿拉斯加原住民患者的指南指导的医疗和器械治疗和结局 通过印度卫生服务中心接受治疗的心力衰竭患者。这一目标将利用大型行政临床 索赔数据库。目标2将通过采用定性研究方法进行访谈来加强这一分析 美国印第安人心衰患者出院后心衰住院，以及原发性 纳瓦霍族的两个印度卫生服务中心的供应商，以更好地了解获得优质心脏的障碍 失败护理目标3将采用一种实施映射方法，同时有一个利益相关者特别工作组， 研究中心，以确定最高优先级的策略，以改善该人群的心力衰竭护理。这些目标 将导致未来在纳瓦霍民族的美国印第安人心脏衰竭的试点实用临床试验， 将用于评估目标3中确定的改善护理的最高优先战略的有效性。 这些研究目标是一个全面的培训计划的一部分，将由一个导师监督， 由卫生服务和实施科学研究方面的国家领导人组成的咨询小组，以及 先进的统计和定性方法，并将指导我过渡到一个独立资助的 研究生涯。