Goal concordance in rheumatoid arthritis in diverse populations

 描述（由申请人提供）：这个K23指导以患者为导向的研究奖将为候选人詹妮弗巴顿博士提供额外的培训和实践经验。巴顿博士是一名风湿病学家，在一家公立医院工作，他围绕病人与临床医生的沟通和健康差异制定了一项研究议程。为了进一步发展她的职业生涯并实现她的研究计划的目标，巴顿博士需要在三个领域进行额外的培训：1）定性研究方法，2）与测量专家，健康IT和通信专家合作开发患者报告工具，3）先进的生物统计方法。 巴顿博士组建了一个多学科的团队，以确保她成功地实现这一奖项的目标。具体来说，她的主要导师爱德华·叶林博士，风湿性疾病卫生服务研究专家，和共同导师，院长Schillinger博士，国际公认的健康传播专家，在弱势群体中实施干预措施方面具有广泛的专业知识，是唯一能够监督巴顿博士的培训计划和研究战略执行的人。Patricia Katz博士，加州大学旧金山分校的测量科学专家;维克托蒙托里博士，马约诊所的研究员和设计工具的专家，以分享临床遇到的知识; Liana Fraenkel博士，风湿病学家和健康服务研究员，在患者偏好和决策方面拥有丰富的经验; Somnath Saha博士，OHSU健康沟通和慢性病种族差异研究员;斯图尔特·甘斯基（Stuart Gansky）博士是加州大学旧金山分校的生物统计学家，拥有分析不同人群观察性研究数据的经验，他将为巴顿博士提供支持、专业知识和独特的观点。 尽管类风湿性关节炎的治疗选择和策略取得了进展，但少数民族和非英语国家的结果仍然存在显著差异。有效的患者-临床医生沟通是诊断、适当治疗和避免不安全使用或滥用昂贵、潜在毒性治疗的核心。尽管患者和医生之间需要信任的伙伴关系来管理RA，但目标设定仍然是一个未探索的领域，特别是在面临沟通障碍的患者中。因此，在目标1中，巴顿博士将制定患者-临床医生目标一致性的衡量标准;使用混合方法评估目标一致性的程度和预测因素。在目标2中，巴顿博士将评估目标一致性是否与信任、RA自我效能、生活质量和药物依从性相关。在目标3中，她将开发和试点测试一种干预措施，以提高患者目标的诱导，并对干预措施进行更大规模的随机试验。该项目将加深我们对RA目标一致性的理解，并提供必要的培训和实践经验，以确保巴顿博士作为独立临床研究者的成功，并提供RO 1应用的基础，以评估改善RA患者-临床医生沟通和护理质量的干预措施。

 DESCRIPTION (provided by applicant): This K23 Mentored Patient-Oriented Research Award will provide additional training and practical experience for the candidate, Dr. Jennifer Barton. Dr. Barton is a rheumatologist who practices at a public hospital and has developed a research agenda around patient-clinician communication and health disparities. To further develop her career and achieve the goals of her research plan, Dr. Barton requires additional training in three areas: 1) qualitative research methods, 2) collaboration with measurement experts, health IT, and communication experts in development of a patient-reported tool, and 3) advanced biostatistical methods. Dr. Barton has assembled a multidisciplinary team to assure her success in achieving the goals of this award. Specifically, her primary mentor Dr. Edward Yelin, an expert in health services research in the rheumatic diseases, and co-mentor, Dr. Dean Schillinger, an internationally recognized expert in health communication with extensive expertise in implementing interventions among vulnerable populations, are uniquely situated to oversee Dr. Barton's training plan and execution of the research strategy. Dr. Patricia Katz, an expert in measurement science at UCSF; Dr. Victor Montori, a Mayo Clinic investigator and expert in the design of tools to share knowledge in the clinical encounter; Dr. Liana Fraenkel, a rheumatologist and health services researcher with extensive experience in patient preference and decision making; Dr. Somnath Saha, OHSU researcher in health communication and racial disparities in chronic disease; and Dr. Stuart Gansky, a UCSF biostatistician with experience analyzing data from observational studies of diverse populations, will provide support, expertise, and unique perspectives to Dr. Barton. Despite advances in treatment options and strategies for rheumatoid arthritis, significant disparities in outcomes among ethnic minorities and non-English speakers persist. Effective patient-clinician communication is central to the diagnosis, appropriate treatment, and avoidance of unsafe use or misuse of costly, potentially toxic therapies. Despite the need for a trusting partnership between patient and doctor to manage RA, goal- setting remains an unexplored domain, especially among patients who face barriers to communication. Therefore, in Aim 1, Dr. Barton will develop a measure of patient-clinician goal concordance; assess the extent and predictors of goal concordance using a mixed methods approach. In Aim 2, Dr. Barton will evaluate whether goal concordance is associated with trust, RA self-efficacy, quality of life, and medication adherence. In Aim 3, she will develop and pilot-test an intervention to enhance the elicitation of patient goals and conduct a larger, randomized trial of the intervention. This project will deepen our understanding of goal concordance in RA, as well as provide necessary training and practical experience to ensure Dr. Barton's success as an independent clinical investigator, and provide the basis of an RO1-application to evaluate an intervention to improve patient-clinician communication and quality of care in RA.