Overcoming Barriers to Effective Care for Minorities

说明(由申请人提供)：少数群体的健康状况可能比大多数人更差，因为他们较少接受被证明有效的卫生保健服务。改善患者自我管理很可能是改善有效护理交付的关键杠杆点。如果对增加有效保健服务提供的干预措施进行仔细的量身定做，以解决它们试图补救的使用不足问题的具体原因，则可能是最有效的。我们现在正在进行许多多机构研究和社区外联项目，以改善向纽约市东哈莱姆区和中心区少数族裔社区提供有效护理的情况。我们建议围绕通过提高东哈莱姆区和中部哈莱姆区患者的自我管理技能来改善健康和减少差距的主题来发展我们的中心。我们中心的研究核心将加强两个已经资助的干预试验，以检验同行领导的患者支持小组干预的有效性(一个在高血压患者中，另一个在中风患者中)；我们将在第三个已经资助的试验中增加一项干预措施，将妇女与早期乳腺癌患者和对现有社区服务支持的特定需求相匹配。一个充满活力的社区推广核心将致力于将成功的项目嵌入社区，以最大限度地提高在研究研究结束后保留这些项目的可能性，这将补充这些研究战略。我们将加强现有的联系，并与社区领导人和组织建立新的联系，以保持社区、研究人员和教育工作者之间的相互信息交流。本中心将在其培训活动中追求互补的目标。我们建议深化与北方综合医院的合作伙伴关系，北方综合医院是除东哈莱姆区或中部哈莱姆区西奈山以外唯一的私立医院。我们将让North General参与加强我们的研究，就像我们对已经资助的研究所做的那样。我们将开设一个多层面的临床研究培训计划，广泛介绍临床研究的概念和方法，并更密切地吸引选定的北方普通教师，以加强我们社区的少数族裔卫生服务研究基础设施，并促进少数族裔教师进入研究生涯。

DESCRIPTION (provided by applicant): Minority populations may experience poorer health status than the majority because they receive proven effective health care services less often. Improving patient self-management is most likely a critical leverage point in improving the delivery of effective care. Interventions to increase the delivery of effective health care services are likely to be most effective if they are carefully tailored to address the specific causes of the under use problems they seek to remedy. We have many multi-institutional research and community outreach projects underway now to improve the delivery of effective care to the minority communities of East and Central Harlem in New York City. We propose to develop our Center around the theme of improving health and reducing disparities by enhancing self-management skills among patients in East and Central Harlem. Our Center's research core will enhance 2 already-funded intervention trials to examine the effectiveness of a peer-led patient support group intervention (one in patients with uncontrolled hypertension and a second in those with stroke); we will add to a third already-funded trial an intervention that will match women with early-stage breast cancer and specific needs for support to existing community services. A vigorous community outreach core that will aim to embed successful programs in the community to maximize the likelihood that they will remain after the research studies are concluded will supplement these research strategies. We will strengthen existing linkages and build new ones with community leaders and organizations to maintain a mutual exchange of information between the community, researchers, and educators. Our Center will pursue complementary objectives in its training activities. We propose to deepen our partnership with North General Hospital, the only private hospital other than Mount Sinai in East or Central Harlem. We will involve North General in the enhancements to our research studies, as we have with the already-funded research. We will inaugurate a multi-faceted clinical research training program that will introduce clinical research concepts and methods broadly and engage selected North General faculty more intensively to enhance the minority health services research infrastructure in our community and to facilitate the entry of minority faculty into research careers.