Racial Disparity in the Utilization of Joint Replacement for Osteoarthritis

描述（由申请人提供）：宾夕法尼亚大学医学教授、VA国家健康公平研究与促进中心（CHERP）联合主任赛义德·易卜拉欣（Said Ibrahim）博士寻求延长K24面向患者研究的中期职业研究者奖，以继续这一富有成效的研究项目，同时投入大量时间指导下一代医学生、住院医生、临床和博士后研究员以及初级教员实习生，特别是代表性不足的少数民族。在他的研究领域。尽管为改善弱势群体的保健和保健质量和公平性采取了近25年的国家举措，但2011年AHRQ《全国保健和差距报告》得出的结论是，保健质量和获得机会仍然不够理想，对少数民族和低收入群体而言尤其如此。最近的一项经济分析表明，2003年至2006年期间，卫生不平等和过早死亡的直接和间接成本为1.24万亿美元。因此，卫生公平研究直接解决了一个无情的卫生保健问题，它对我们国家的公共卫生和经济造成了巨大的影响。易卜拉欣博士领导了一个完善的研究项目，研究在终末期骨关节炎（OA）治疗中使用关节置换术的种族差异。他在理解和干预膝关节/髋关节骨性关节炎管理中获得和利用关节置换术的种族差异方面的工作为推进健康差异研究提供了一个国家模型，从第一代研究发现护理差异到第二代研究探索这些差异的原因，再到有史以来第一代第三代干预试验，以减少这种有充分记录的差异。缺乏导师和榜样是职业发展的一个重要障碍，往往是造成人员流失的原因，特别是在女性和少数族裔教员中。女性和未被充分代表的少数族裔报告说，在受到保护的时间和精力下，找到成熟导师的难度更大

DESCRIPTION (provided by applicant): Dr. Said Ibrahim, a Professor of Medicine at Penn and Co-Director of the VA National Center for Health Equity Research and Promotion (CHERP), seeks the extension of the K24 Mid-Career Investigator Award in Patient-Oriented Research to continue this fruitful research program while dedicating significant time for mentoring the next generation of medical students, residents, clinical and post-doctoral fellows, and junior faculty trainees, particularly under-represented minorities, in his field of research. Despite nearly 25 years of national initiatives to improve the quality and equity of health and health care for vulnerable populations, the 2011 AHRQ National Healthcare and Disparities Report concluded that health care quality and access remain suboptimal, especially for minority and low-income groups. A recent economic analysis demonstrated that the direct and indirect costs of health inequalities and premature death were $1.24 trillion between 2003 and2006. Thus, health equity research directly addresses an unrelenting health care problem with overwhelming public health and economic consequences for our nation. Dr. Ibrahim leads a well-established research program on racial disparities in utilization of joint replacement in the management of end-stage osteoarthritis (OA). His work on understanding and intervening on racial disparity in access and utilization of joint replacement in the management of knee/hip OA provides a national model for advancing health disparities research from first- generation studies that detected disparities in care to second-generation studies exploring the reasons for these disparities to the first-ever third-generation intervention trials to reduce this well-documented disparity. The absence of mentors and role models is an important barrier to career advancement and is often the cause of attrition, particularly among women and minority faculty. Women and underrepresented minorities report greater difficulty finding established mentors with the protected time and effort to mentor. This has led to the call for more effective, constructive nurturing of minority faculty mentors and emphasis on promoting their careers in academic medicine. This candidate has a track record of mentoring underrepresented trainees and those who are interested in health equity research careers. Over the course of this award, the candidate will devote 45-50% effort each year to mentoring. Starting with 6 mentees in Year one, he will add 4 new mentees each subsequent year. The candidate will mentor approximately 5 students and/or residents, 5 fellows, and 8 junior faculty members in patient-oriented research in the course of this award. Therefore, the specific aims of the proposed K24 renewal application are: 1) To continue and advance a trajectory of research to understand and intervene on racial disparity in the management of end-stage knee/hip OA and access to joint replacement; 2) To provide mentoring for the future generation of patient-oriented health equity investigators; and 3) To continue Dr, Ibrahim's leadership role in national and institutional efforts to diversify the U.S. health care research workforce.