Cardiovascular Disease Epidemiology in Medicaid Patients with Lupus

简介(申请人提供)：自完成风湿学研究和研究培训以来，科斯滕巴德博士一直致力于以患者为导向的风湿病研究。她曾担任33名博士后和博士后学员的初级或二级研究导师。除了担任布里格姆和妇女医院狼疮中心联席主任的职位外，科斯滕巴德博士的指导还得益于她参与了几个哈佛大学的教学和培训项目。此外，候选人正在进行的多个以患者为导向的研究项目和合作、对指导的承诺以及特殊的机构资源为以患者为导向的风湿病研究的初级研究人员的发展提供了出色的环境。这笔K24拨款将保留科斯滕巴德博士受保护的时间，并减轻未来的临床和管理责任。提出的新研究目标将建立在过去使用2000-2010年医疗补助数据在全国范围内的狼疮人群中所做的工作的基础上。利用美国超过66,000名狼疮患者的数据，这些研究将解决有关心血管疾病风险、内科和外科护理以及结果的关键未解问题。这些重要的问题包括：心血管疾病风险在这一人群中是否随着时间的推移而变化，心脏事件后的风险和干预风险与普通人群相比如何，狼疮患者是否得到最佳的心脏护理，以及羟基氯喹是否降低心血管疾病风险。这一弱势群体固有的社会人口学差异和高医疗风险使这些研究与正在进行的关于改善医疗保健和结果的政策讨论极其相关。这些强有力的研究结果将为未来提供信息。此外，拟议的研究性研究将提供极好的指导机会。科斯滕巴德博士将继续每年在她的风湿病流行病学和结果研究项目中招募两到三名新的实习生，并利用从实习生那里收到的反馈、医疗护理和处方实践以及布里格姆妇女医院和哈佛医学院的研讨会和讲座来扩大和完善她的正式指导计划。基于机构承诺和资源以及科斯滕巴德博士在研究和指导方面的成功记录，这笔K24赠款将极大地增强她扩大现有研究指导计划和培养下一代以患者为导向的风湿病研究人员的能力。

DESCRIPTION (provided by applicant): Since completing her rheumatology fellowship and research training, Dr. Costenbader has devoted her career to patient-oriented rheumatic disease research. She has served as primary or secondary research mentor for 33 pre- and post-doctoral trainees. Along with her position as Co-Director of the Brigham and Women's Hospital Lupus Center, Dr. Costenbader's mentoring is facilitated by her affiliations with several Harvard teaching and training programs. Moreover, the candidate's multiple ongoing patient-oriented research projects and collaborations, commitment to mentoring, and exceptional institutional resources provide an outstanding environment for the development of junior investigators in patient-oriented rheumatic disease research. This K24 grant would preserve Dr. Costenbader's protected time and relieve future clinical and administrative responsibilities. The new research aims proposed will build upon past work in a large, nationwide lupus population with Medicaid data from 2000-2010. With data on over 66,000 lupus patients in the U.S., these studies will address key unanswered questions about cardiovascular disease risks, medical and surgical care, and outcomes. These important questions include whether cardiovascular disease risks are changing over time in this population, how post-cardiac event and intervention risks compare to those of the general population, whether lupus patients receive optimal cardiac care, and whether hydroxychloroquine reduces cardiovascular disease risks. The inherent sociodemographic variation and high medical risk of this vulnerable population make these studies extremely relevant for ongoing policy discussions about improving healthcare and outcomes. The findings of these powerful studies will inform future . Moreover, the proposed research studies will provide excellent mentoring opportunities. Dr. Costenbader will continue to recruit two to three new trainees into her rheumatic disease epidemiology and outcomes research program each year, and to expand and refine her formal mentoring program using feedback received from trainees, medical care and prescribing practices and seminars and lectures at the Brigham and Women's Hospital and Harvard Medical School. Based on institutional commitment and resources and Dr. Costenbader's successful record in research and mentoring, this K24 grant would greatly augment her ability to expand her existing research mentoring program and to develop the next generation of patient-oriented rheumatic disease investigators.