Investigating healthcare for rural females with complex gynecological conditions

我们建议的研究项目非常有价值地直接建立在科布雷取得的进展和见解的基础上 试点项目第1年和第2年，关于农村先天性子宫妇女的医疗保健和结局 异常(CUAS，也称为穆勒异常)，美国国立卫生研究院(NIH)的性和 性别少数民族健康差距研究人群。CUA是女性发展的差异 生殖道，影响到约7%的一般女性人口，导致各种健康问题 包括妊娠并发症、盆腔疼痛、不孕不育，在严重情况下，子宫和上半身缺如 阴道的一部分。患有慢性阻塞性肺病的女性需要一系列与诊断相关的医疗专业知识， 在他们一生中接受治疗和后续护理。拟议的项目提供了一个宝贵的机会 要：(1)让我们的比林斯诊所CUA患者社区参与焦点小组，以根据所获得的见解进行扩展 从第二年的关键信息者访谈中，确定未来以患者为导向的研究的优先事项；(2)评估 西部山区卫生系统行政记录，以(A)揭示州际公路的流行和程度 在西部山区接受CUA患者护理所需的旅行，以及(B)分层妇科癌症 根据癌症类型和异常变异对患有CUAS的妇女的风险；以及(3)检查 与CUA相关的医疗程序相关的财务负担和保险障碍，以揭示程度 在医疗费用和获得必要医疗服务方面的重大复合差距 为这个患者群体提供生殖护理。鉴于我们有能力继续与我们的 CUA患者和提供者社区，该项目将支持持续的数量和质量 分析临床结果和患者体验，加强与区域患者的合作 和他们的供应商穿过西部山区。成功完成我们的目标最终将确保 将患者作为研究合作伙伴，与关心以下问题的区域提供商培养更广泛的合作机会 这些妇女(包括未来的招募)，并揭示有价值的临床数据结果，以支持 竞争性R01提交。

Our proposed Research Project valuably builds directly upon the progress and insights obtained in COBRE Pilot Project Years 1 and 2 regarding healthcare and outcomes for rural females with congenital uterine anomalies (CUAs, also known as Mullerian Anomalies), a National Institutes of Health (NIH) Sexual and Gender Minority health disparity research population. CUAs are differences of development of the female reproductive tract, impacting ~7% of the general female population, resulting in a variety of health concerns including pregnancy complications, pelvic pain, infertility, and in severe cases, absence of uterus and upper portion of vagina. Females with CUAs require a range of healthcare expertise related to diagnoses, treatment and follow up care throughout their lifetime. The proposed project provides a valuable opportunity to: (1) engage our Billings Clinic CUA patient community in focus groups to expand upon insights obtained from Year 2 key informant interviews, and to define priorities for future patient-driven research; (2) assess Mountain West health system administrative records to (a) reveal the prevalence and extent of interstate travel required to receive care for CUA patients in the Mountain West, and (b) stratify gynecological cancer risk for women with CUAs according to type of cancer and variation of anomaly; and (3) examine the financial burdens and insurance barriers related to CUA-related healthcare procedures to reveal the extent of important compounding disparities in terms of healthcare cost and access to medically necessary reproductive care for this patient community. Given our ability to continue fostering partnerships with our CUA patient and provider community, the project will support the continued quantitative and qualitative analysis of clinical outcomes and patient experiences, and strengthen collaborations with regional patients and their providers across the Mountain West. Successful completion of our aims will ultimately assure patients as research partners, foster broader collaboration opportunities with regional providers caring for these women (including for future recruitment), and reveal valuable clinical data outcomes to support a competitive R01 submission.