Quality and Equity in Osteoarthritis: Understanding & Improving Treatment Use

骨关节炎的质量和公平：理解

• 批准号: 9040883
• 负责人: Ernest R Vina
• 金额: $ 17.79万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-03-26 至 2020-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9040883
• 关键词: Address; African American; Anti-Inflammatory Agents; Anti-inflammatory; Area; Arthritis; Attitude; Belief; Caring; Characteristics; Clinical; Clinical Practice Guideline; Clinical Trials; Degenerative polyarthritis; Disease; Elderly; Exercise; Goals; Health; Healthcare; Hip region structure; Intervention; Knee; Knowledge; Lead; Learning; Mediating; Medical; Medicine; Methods; Modality; Musculoskeletal Diseases; Narcotics; Operative Surgical Procedures; Opioid; Outcome; Pain; Pain management; Patient Care; Patients; Pharmaceutical Preparations; Physical therapy; Pilot Projects; Placebos; Process; Publishing; Quality of Care; Race; Recording of previous events; Reporting; Research; Rheumatism; Risk; Self Care; Severity of illness; Source; Statistical Models; Surveys; Testing; Treatment Efficacy; Update; career; disability; disabling disease; disparity reduction; evidence base; experience; group intervention; health belief; health care disparity; improved; improved outcome; instrument; interest; patient oriented; personalized medicine; primary outcome; psychosocial; racial difference; racial disparity; racial health disparity; racial minority; shared decision making; skills training; therapy design; therapy development; tool; treatment disparity

 DESCRIPTION (provided by applicant): Candidate Career Goals: Dr. Ernest R. Vina's long-term career goal is to promote equity for patients with rheumatic and musculoskeletal diseases through the development of interventions to eliminate racial disparities and improve outcomes for patients with these diseases. With his research and clinical experience in addressing the sources of racial disparities in the health and health care of patients with rheumatic diseases, Dr. Vina is well-suited to build a research career in this area. However, he will require additiona training and skills in order to address knowledge gaps by exploring patient characteristics and health beliefs that may contribute to disparities in the medical care of patients with osteoarthrits (OA). Dr. Vina's short-term career goals are 1) to develop the expertise required to study the reasons why race disparities in the use of different types of non-surgical OA treatment exist; and 2) to learn to develop an intervention and implement a clinical trial to reduce racial disparities n the use of various OA treatments. Research Background: OA is a highly prevalent and disabling disease. Racial disparities in the outcomes of OA patients have also been demonstrated, with African-Americans (AAs) carrying a greater burden than whites (WHs). In addition, AAs are also less likely to have history of use of various pharmacologic and non- pharmacologic therapies for OA. Sources of racial healthcare disparities in OA are only partially known. Research Aims: There are two main aims for this K23. The first is to examine the determinants of, and barriers to, the utilization of various OA treatments that contribute to disparities in the care of AAs and WHs. The second is to pilot-test the impact of an intervention designed to improve the utilization of effective, non- surgical OA treatments. Methods: To achieve the goals of the first aim, surveys of patients with knee or hip OA will be conducted. The survey will determine patient demographic information, psychosocial characteristics, disease severity, treatment history and health-related knowledge, beliefs and attitudes. The primary outcomes of interest will include utilization of various treatments, including exercises, topical medications, non-steroidal anti- inflammatory drugs and opioid agents. Hierarchical statistical modeling will be conducted to determine which patient-level variables may mediate racial disparities in the utilization of the various OA treatments. For the second aim, an existing educational tool will be chosen and enhanced with the goal of improving patient understanding of OA treatments and increasing the use of available OA therapies. Thereafter, this instrument will be pilot-tested to a relatively smal group of patients with knee or hip OA. The impact of this educational tool in improving the utilization of various OA therapies will be preliminarily determined.

 描述（由申请人提供）： 候选人职业目标：Ernest R. Vina 博士的长期职业目标是通过制定干预措施来消除种族差异并改善风湿性和肌肉骨骼疾病患者的治疗效果，从而促进这些疾病患者的公平。凭借在解决风湿病患者健康和保健方面的种族差异根源方面的研究和临床经验，维纳博士非常适合在这一领域建立研究生涯。然而，他将需要额外的培训和技能，以便通过探索可能导致骨关节炎 (OA) 患者医疗护理差异的患者特征和健康信念来解决知识差距。 Vina 博士的短期职业目标是 1) 培养所需的专业知识，以研究在使用不同类型的非手术 OA 治疗方面存在种族差异的原因； 2) 学习制定干预措施并实施临床试验，以减少使用各种骨关节炎治疗的种族差异。研究背景： OA 是一种高度流行且致残的疾病。骨关节炎患者的结局也存在种族差异，非洲裔美国人 (AA) 比白人 (WH) 承受的负担更大。此外，AA 也不太可能有使用各种药物和非药物治疗 OA 的历史。 OA 中种族医疗保健差异的根源目前尚不明确。研究目标：K23 有两个主要目标。首先是检查使用各种 OA 治疗的决定因素和障碍，这些治疗导致 AA 和 WH 的护理差异。第二个是试点测试旨在提高有效非手术骨关节炎治疗利用率的干预措施的影响。方法：为了实现第一个目标，将对膝关节或髋关节骨关节炎患者进行调查。该调查将确定患者的人口统计信息、心理社会特征、疾病严重程度、治疗史以及健康相关知识、信念和态度。感兴趣的主要结果包括各种治疗的利用，包括锻炼、外用药物、非甾体抗炎药和阿片类药物。将进行分层统计模型来确定哪些患者层面的变量可能会调节各种 OA 治疗使用中的种族差异。对于第二个目标，将选择并增强现有的教育工具，以提高患者对 OA 治疗的理解并增加现有 OA 疗法的使用。此后，该仪器将在相对较小的膝关节或髋关节 OA 患者群体中进行试点测试。该教育工具在提高各种 OA 疗法的利用率方面的影响将得到初步确定。