Racial Disparity in the Utilization of Joint Replacement for Osteoarthritis

描述(申请人提供)：Said Ibrahim博士，宾夕法尼亚大学医学教授和退伍军人事务部国家健康公平研究和促进中心(CHERP)联席主任，寻求延长K24以患者为导向研究的职业中期研究员奖，以继续这一富有成效的研究计划，同时投入大量时间指导他的研究领域的下一代医学生、住院医师、临床和博士后研究员，以及初级教员实习生，特别是代表不足的少数族裔。尽管国家采取了近25年的举措来改善弱势群体的保健和保健的质量和公平性，但2011年AHRQ《国家保健和差异报告》得出结论认为，保健质量和机会仍然不是最优的，特别是对少数群体和低收入群体而言。最近的一项经济分析表明，2003至2006年间，健康不平等和过早死亡造成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，给我们的国家带来了压倒性的公共健康和经济后果。易卜拉欣博士领导着一个关于在终末期骨关节炎(OA)治疗中使用关节置换术的种族差异的成熟研究计划。他在了解和干预膝关节/髋关节置换术治疗中的种族差异方面的工作提供了一个全国性的模型，将健康差异研究从检测护理差异的第一代研究发展到探索这些差异原因的第二代研究，这是有史以来第一次第三代干预试验，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职员工中。妇女和代表性不足的少数族裔报告说，用受保护的时间和精力找到既定导师的难度更大 去当导师。这导致了对少数族裔教师导师进行更有效、更有建设性的培养的呼吁，并强调促进他们在学术医学领域的职业生涯。这位候选人有指导代表性不足的实习生和那些对健康公平研究职业感兴趣的人的记录。在该奖项的整个过程中，候选人每年将投入45%-50%的精力用于指导。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/或住院医生、5名研究员和8名初级教职员工在这个奖项的过程中进行以患者为导向的研究。因此，拟议的K24续签申请的具体目标是：1)继续并推进研究轨迹，以了解和干预终末期膝关节/髋关节骨关节炎和关节置换治疗中的种族差异；2)为未来一代以患者为导向的医疗公平调查员提供指导；以及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研究队伍多元化的领导作用。

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.