Racial Disparities in the Treatment of Psoriasis: A Mixed Methods Approach

 描述（由申请人提供）：该K23奖项提案的总体目标是为候选人Junko Takeshita，MD，PhD所需的额外培训和经验提供支持，以便从最近的博士后实习生和目前的皮肤科讲师过渡到独立的以患者为导向的研究者，重点关注银屑病的健康和医疗保健差异。具体而言，本提案的目的是确定，定义和理解非裔美国人和高加索人医疗保险受益人在治疗银屑病方面的差异。我们假设：1）在非裔美国人和高加索人银屑病患者中，特定银屑病治疗的开始和治疗的持续性是不同的，2）在患者水平因素（如银屑病的感知和两个种族群体之间对治疗的态度）方面存在重要差异，这有助于银屑病的差异治疗。由于临床医生目前不知道存在的差距， 银屑病治疗，我们寻求改变目前的临床实践范例与此建议，通过新的识别和建立一个理解的种族差异，在银屑病治疗的目标，减少任何确定的差异，并最终改善治疗和临床结果，特别是在非洲裔美国人银屑病患者。将采用序贯混合方法来实现拟定目标：i）首先，将使用Medicare数据进行定量纵向队列研究，以比较患有银屑病的非裔美国人和高加索人Medicare受益人之间的治疗开始和治疗持续时间;和ii）第二，定性研究，由定量研究的结果提供信息，将使用半结构化访谈和自由列表进行，以确定非裔美国人和高加索人之间确定的银屑病治疗差异的患者水平决定因素。为了实现这些目标，候选人将需要在三个关键领域的培训：1）使用医疗保险索赔数据; 2）差异研究方法;和3）定性和混合方法研究。候选人的培训计划，其中包括教学课程的结合，通过完成她提出的研究的实践经验，并在五年的奖励期间从她的专家指导团队指导，这将使她能够作为一名独立的患者调查员开始一个成功的职业生涯-通过对银屑病护理差异的研究，为皮肤病学领域做出重要贡献。

 DESCRIPTION (provided by applicant): The overall objective of this K23 award proposal is to provide support for the additional training and experience necessary for the candidate, Junko Takeshita, MD, PhD, to transition from recent post-doctoral trainee and current Instructor in Dermatology to an independent patient-oriented investigator with a focus on health and healthcare disparities in psoriasis. Specifically, the aims of this proposal are to identify, defin, and understand disparities between African American and Caucasian Medicare beneficiaries in the treatment of psoriasis. We hypothesize that: 1) initiation of specific psoriasis therapies and persistence on therapies are different between African American and Caucasian patients with psoriasis, and 2) there are important differences in patient-level factors such as perceptions of psoriasis and attitudes towards treatments between the two racial groups that contribute to differential treatment of psoriasis. As clinicians are currently unaware of existing disparities in psoriasis treatment, we seek to shift current clinical practice paradigms with this proposal by newly identifying and establishing an understanding of racial disparities in the treatment of psoriasis with the goal of reducing any identified disparities and ultimately improving treatment and clinical outcomes, particularly among African American patients with psoriasis. A sequential mixed methods approach will be utilized to address the proposed aims: i) first, a quantitative longitudinal cohort study using Medicare data will be performed in order to compare initiation of therapies and persistence on therapies between African American and Caucasian Medicare beneficiaries with psoriasis; and ii) second, a qualitative study, informed by results from the quantitative study, will be performed using semi-structured interviews and freelists in order to identify patient- level determinants of the identified psoriasis treatment disparities between African Americans and Caucasians. In order to achieve these goals, the candidate will need training in three critical areas: 1) use of Medicare claims data; 2) disparities research methods; and 3) qualitative and mixed methods research. The candidate's training plan, which includes a combination of didactic coursework, practical experience through the completion of her proposed research, and directed mentorship from her expert mentoring team over the five year award period, will enable her to launch a successful career as an independent investigator in patient-oriented research and make important contributions to the field of dermatology via the study of disparities in the care of psoriasis.