Racial disparities in access to high quality hospitals for coronary heart disease

描述(由申请人提供)：这份K08申请的主要目标是支持Loana Popescu博士成为心血管疾病种族差异领域的独立研究员。这项应用将涉及吸收新的方法技能和分析一些现有的保健数据库。为了支持这项申请，波佩斯库博士组建了一支经验丰富的导师团队。加里·罗森塔尔(内科)、杰拉尔德·拉什顿(地理学)和凯文·莱希特(社会学)，他们带来了互补方法学领域的专业知识，并协助波佩斯库博士设计职业发展和研究的综合计划。职业生涯规划包括以下方面的高级培训：1)分级生物统计建模和临床研究伦理；2)空间分析和地理信息系统方法在卫生保健中的应用；3)测量居住隔离的方法和了解其社会学根源。这些目标将通过有针对性的课程作业、教程、定向阅读和由她的导师指导的直接研究经验来实现。研究计划将研究地理位置、种族隔离和医疗保健系统因素之间的相互作用，以全面了解为什么黑人患者不太可能在高质量的医院接受急性心肌梗死、经皮冠状动脉介入治疗和冠状动脉搭桥手术。研究计划包括三个增量目标，它们利用了许多国家数据来源，包括：联邦医疗保险住院和门诊患者索赔文件；美国人口普查数据；美国医院协会调查；美国医学会医师总档案；以及达特茅斯阿特拉斯医疗保健市场数据。目标1将考察种族、与入院者和高质量医院的接近程度以及进入高质量医院的可能性之间的关系。目标2将评估居住隔离对高质量医院入院人数差异的影响。AIM 3将研究先前门诊护理模式对进入高质量医院的差异的影响，并将培养波佩斯库博士在分析更复杂的门诊医生索赔文件方面的流利性。

DESCRIPTION (provided by applicant): The primary goal of this K08 application is to support Dr loana Popescu to become an independent investigator in the area of racial disparities in cardiovascular disease. The application will involve the assimilation of new methodological skills and the analysis of a number of existing health care databases. In support of the application, Dr. Popescu has assembled a team of experienced mentors-Drs. Gary Rosenthal (Department of Internal Medicine), Gerald Rushton (Geography), and Kevin Leicht (Sociology), who bring expertise in complementary methodological areas and who have assisted Dr. Popescu in designing integrated plans for career development and research. The Career Plan includes advanced training in: 1) hierarchical biostatistical modeling and clinical research ethics; 2) the application of spatial analysis and geographic information systems methods in health care; and 3) methods for measuring residential segregation and understanding its sociological roots. These goals will be accomplished through targeted coursework, tutorials, directed readings, and direct research experiences guided by her mentors. The Research Plan will examine the interplay between geography, segregation and health care system factors, in order to build a comprehensive understanding of why black patients are less likely to receive care for acute myocardial infarction, percutaneous coronary intervention, and coronary artery bypass surgery in high quality hospitals. The Research Plan includes three incremental aims that capitalize on a number of national data sources, including: Medicare inpatient and outpatient claims files; US Census data; American Hospital Association surveys; the American Medical Association Physician Masterfile; and Dartmouth Atlas health care market data. Aim 1 will examine the relationship between race, proximity to the admitting and to high quality hospitals, and the likelihood of admission to high quality hospitals. Aim 2 will evaluate the effects of residential segregation on disparities in admissions to high quality hospitals. Aim 3 will examine the effects of patterns of prior outpatient care on disparities in admission to high quality hospitals and will build Dr. Popescu's fluency in analyzing more complex outpatient physician claims files.