Racial disparities in access to high quality hospitals for coronary heart disease

描述（由申请人提供）：本K08申请的主要目标是支持loana Popescu博士成为心血管疾病种族差异领域的独立研究者。这项应用将涉及吸收新的方法技能和分析一些现有的保健数据库。为了支持这项申请，波佩斯库博士组建了一个由经验丰富的导师组成的团队。Gary Rosenthal（内科），Gerald Rushton（地理）和Kevin Leicht（社会学），他们带来了互补方法学领域的专业知识，并协助Popescu博士设计了职业发展和研究的综合计划。职业规划包括以下方面的高级培训：1)分层生物统计建模和临床研究伦理；2)空间分析和地理信息系统方法在卫生保健中的应用；3)衡量居住隔离的方法和理解其社会学根源。这些目标将通过有针对性的课程、辅导、指导阅读和导师指导下的直接研究经验来实现。该研究计划将研究地理、隔离和卫生保健系统因素之间的相互作用，以便全面了解为什么黑人患者在高质量医院接受急性心肌梗死、经皮冠状动脉介入治疗和冠状动脉搭桥手术的可能性较低。研究计划包括三个增量目标，利用一些国家数据来源，包括：医疗保险住院和门诊索赔文件；美国人口普查数据；美国医院协会调查；美国医学会医师大师档案；达特茅斯Atlas医疗保健市场数据。目的1将检查种族，接近入院和高质量医院之间的关系，以及进入高质量医院的可能性。目标2将评估居住隔离对高质量医院入院差异的影响。目的3将检查先前门诊治疗模式对高质量医院入院差异的影响，并将建立Popescu博士在分析更复杂的门诊医生索赔文件方面的流畅性。

DESCRIPTION (provided by applicant): The primary goal of this K08 application is to support Dr loana Popescu to become an independent investigator in the area of racial disparities in cardiovascular disease. The application will involve the assimilation of new methodological skills and the analysis of a number of existing health care databases. In support of the application, Dr. Popescu has assembled a team of experienced mentors-Drs. Gary Rosenthal (Department of Internal Medicine), Gerald Rushton (Geography), and Kevin Leicht (Sociology), who bring expertise in complementary methodological areas and who have assisted Dr. Popescu in designing integrated plans for career development and research. The Career Plan includes advanced training in: 1) hierarchical biostatistical modeling and clinical research ethics; 2) the application of spatial analysis and geographic information systems methods in health care; and 3) methods for measuring residential segregation and understanding its sociological roots. These goals will be accomplished through targeted coursework, tutorials, directed readings, and direct research experiences guided by her mentors. The Research Plan will examine the interplay between geography, segregation and health care system factors, in order to build a comprehensive understanding of why black patients are less likely to receive care for acute myocardial infarction, percutaneous coronary intervention, and coronary artery bypass surgery in high quality hospitals. The Research Plan includes three incremental aims that capitalize on a number of national data sources, including: Medicare inpatient and outpatient claims files; US Census data; American Hospital Association surveys; the American Medical Association Physician Masterfile; and Dartmouth Atlas health care market data. Aim 1 will examine the relationship between race, proximity to the admitting and to high quality hospitals, and the likelihood of admission to high quality hospitals. Aim 2 will evaluate the effects of residential segregation on disparities in admissions to high quality hospitals. Aim 3 will examine the effects of patterns of prior outpatient care on disparities in admission to high quality hospitals and will build Dr. Popescu's fluency in analyzing more complex outpatient physician claims files.