Racial Disparity in the Utilization of Joint Replacement for Osteoarthritis

描述（申请人提供）：赛义德·易卜拉欣博士是宾夕法尼亚大学医学教授，也是弗吉尼亚州国家健康公平研究和促进中心（CHERP）的联合主任，他寻求延长K24中期职业研究者奖，以患者为导向的研究，以继续这一富有成效的研究计划，同时投入大量时间指导下一代医学生，居民，临床和博士后研究员，以及初级教员学员，特别是代表性不足的少数民族，在他的研究领域。尽管近25年来，国家采取了各种举措，以提高弱势群体的健康和保健质量和公平性，但2011年AHRQ《国家保健和差距报告》得出结论认为，保健质量和获得保健的机会仍然不够理想，特别是对少数民族和低收入群体而言。最近的一项经济分析表明，2003年至2006年期间，健康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，健康公平研究直接解决了一个无情的医疗保健问题，对我们国家的公共卫生和经济产生了巨大的影响。Ibrahim博士领导了一项关于终末期骨关节炎（OA）治疗中关节置换术使用的种族差异的完善研究计划。他在了解和干预膝关节/髋关节OA管理中关节置换术的获取和利用方面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，从检测护理差异的第一代研究到探索这些差异原因的第二代研究，再到有史以来第一个第三代干预试验，以减少这种有据可查的差异。缺乏导师和榜样是职业发展的一个重要障碍，往往是自然减员的原因，特别是在妇女和少数民族教师中。妇女和代表性不足的少数民族报告说，在有保护的时间和精力的情况下， 去指导别人这导致了呼吁更有效，建设性地培养少数民族教师导师，并强调促进他们的职业生涯在学术医学。这位候选人有辅导代表性不足的学员和那些谁是健康公平研究事业感兴趣的跟踪记录。在这个奖项的过程中，候选人将每年投入45-50%的精力进行指导。从第一年的6名学员开始，他将在随后的每一年增加4名新学员。候选人将指导大约5名学生和/或居民，5名研究员和8名初级教师在本奖项的过程中进行以患者为导向的研究。因此，拟议的K24更新申请的具体目的是：1）继续并推进研究轨迹，以了解和干预终末期膝关节/髋关节OA管理和关节置换的种族差异; 2）为未来一代以患者为导向的健康公平研究者提供指导;和3）继续发挥易卜拉欣博士在国家和机构努力实现美国医疗保健研究队伍多元化方面的领导作用。

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.