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

此K08应用程序的主要目标是支持Loana Popescu博士成为独立的 心血管疾病种族差异领域的调查员。该应用程序将涉及 吸收新的方法技能和分析一些现有的卫生保健数据库。在……里面 在该应用程序的支持下，Popescu博士组建了一支经验丰富的导师团队。加里 罗森塔尔(内科)、杰拉尔德·拉什顿(地理学)和凯文·莱希特(社会学)， 他们带来了互补方法学领域的专业知识，并协助波佩斯库博士 设计职业发展和研究的综合计划。 职业生涯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；以及 3)测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作业、教程、定向阅读和直接的研究经验来完成 在她的导师的指导下。 研究计划将审查地理位置、种族隔离和医疗保健系统之间的相互作用 因素，以便全面了解为什么黑人患者不太可能得到护理 对于急性心肌梗死、经皮冠状动脉介入治疗和冠状动脉搭桥术 高质量的医院。研究计划包括三个增量目标，这些目标利用了一些 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；美国医学协会医师档案；和达特茅斯地图集 医疗保健市场数据。目标1将考察种族、接近录取者和 高质量的医院，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率差异的影响。Aim 3将审查 既往门诊服务模式对高质量医院入院和意愿差异的影响 培养波佩斯库博士在分析更复杂的门诊医生索赔文件方面的流畅性。 相关性(请参阅说明)： 尽管持续受到全国的关注，但在关于#年种族差距原因的研究中仍然存在重大差距 心血管疾病。建议中的项目将对阐明 地理和社会背景因素导致了这些持续的差异。

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 DartmouthAtlas 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. RELEVANCE (See instructions): Despite sustained national attention, significant gaps remain in research on causes of racial disparities in cardiovascular disease. The proposed projects will bring an important contribution to elucidating the geographic and social context factors contributing to these persistent disparities.