Determining disparities in treatment of pulmonary arterial hypertension nationally

项目总结/摘要 肺动脉高压（PAH）是一种严重的肺血管疾病，其特征是高血压， 症状负担、显著的医疗保健利用和较差的生存率。最近开发的靶向治疗 改善了PAH患者的结局;然而，该疾病仍然被严重低估， 当患者在PAH转诊中心外接受治疗时，治疗不足。尽管早期的重要性 诊断和开始治疗改变疾病轨迹，对PAH的影响知之甚少 在人群水平上的护理，包括潜在的患者、环境或系统水平的治疗决定因素 PAH。单中心研究表明，不同种族/民族之间可能存在PAH结局差异 或社会经济地位群体，尽管造成这些差异的因素，如 这些人群的治疗率仍有待确定。扩大我们对PAH护理的理解 除了PAH登记数据和单中心队列研究之外，对缩小人群水平的护理差距至关重要。 在国家、多样化、综合的卫生系统（如退伍军人医疗保健系统）中获取护理的管理数据 卫生管理局（VA）可以作为一个重要的工具，以提高我们对PAH的交付的理解 在通常的社区实践中进行护理，并检测PAH中的健康差异。为了充分利用这一丰富的数据资源， 为此，我们必须首先建立健全的机制，以确定PAH在行政数据，机制 这是目前这个领域所缺乏的。我提出两个基本步骤，以加强我们对 在社区中提供PAH护理的驱动因素，并满足PAH研究中目前未满足的需求：1）创建和 验证区分PAH与其他更常见形式的肺动脉高压的算法， 管理数据和2）确定PAH治疗的患者和机构水平决定因素。完成 这项研究提案将通过产生一系列经过验证的工具来推进PAH领域， 研究人员可以更好地解决各种研究问题，并通过揭示PAH护理的驱动因素， 在人口水平上提供服务，包括治疗率方面的种族/族裔和经济差异。的结果 这项研究将为建立和实施有效的策略以改善治疗奠定基础 降低PAH患者的发病率并减轻健康差异。与此同时，我通过这门课获得的技能 研究项目和补充教学培训将推动我成为一个领先的职业目标 独立调查员专注于识别和解决心肺健康差异。

PROJECT SUMMARY/ABSTRACT Pulmonary arterial hypertension (PAH) is a severe disease of the pulmonary vasculature characterized by high symptom burden, significant healthcare utilization, and poor survival. Recently developed targeted therapies have improved outcomes for patients with PAH; however, the disease remains significantly underrecognized and undertreated when patients are managed outside of PAH referral centers. Despite the importance of early diagnosis and initiation of treatment in altering the disease trajectory, little is known about the influences on PAH care on a population level including potential patient-, environment-, or system-level determinants of treatment for PAH. Single-center studies suggest that disparities in PAH outcomes may exist among different racial/ethnic or socioeconomic status groups, though the factors that account for these differences such as disparities in treatment rates among these populations remain to be determined. Expanding our understanding of PAH care beyond PAH registry data and single-center cohort studies is essential to close care gaps on a population level. Administrative data that captures care within a national, diverse, integrated health system such as the Veteran’s Health Administration (VA) can serve as an important tool to improve our understanding of the delivery of PAH care in usual community practice and to detect health disparities in PAH. To capitalize on this rich data resource for this purpose, we must first establish sound mechanisms to identify PAH in administrative data, mechanisms that are currently lacking in this field. I propose two foundational steps to enhance our understanding of the drivers of PAH care delivery in the community and to fill currently unmet needs in PAH research: 1) create and validate algorithms to differentiate PAH from other, more common forms of pulmonary hypertension in administrative data and 2) identify patient- and facility-level determinants of treatment for PAH. Completion of this research proposal will advance the field of PAH by generating a collection of validated tools that other PAH researchers can utilize to better address diverse research questions and by revealing drivers of PAH care delivery on a population level including racial/ethnic and economic disparities in treatment rates. The results of this study will establish a foundation on which to build and implement effective strategies to improve treatment rates and mitigate health disparities for patients with PAH. Meanwhile, the skills I gain through this mentored research project and complementary didactic training will advance my career goal of becoming a leading independent investigator focused on identifying and addressing cardiopulmonary health disparities.