Kent County Memorial Hospital

RACIAL/ETHNIC DISPARITIES IN HEART FAILURE: A CROSS COHORT COLLABORATION - ABSTRACT HEART FAILURE (HF), AND ITS SUBTYPES DEFINED BY PRESERVED (HFPEF), REDUCED (HFREF) OR MID-RANGE (HFMREF) EJECTION FRACTION ARE A MAJOR AND GROWING PUBLIC HEALTH PROBLEM. THE LONG TERM GOAL OF THIS PROJECT IS TO BETTER UNDERSTAND THE HEALTH DISPARITIES REGARDING HF AND DEFINE EFFECTIVE PREVENTIVE MEASURES THAT MAY REDUCE THESE DISPARITIES. WE PROPOSE TO POOL DATA FROM 10 LARGE LONGITUDINAL COHORT STUDIES TO EXAMINE RACE/ETHNIC AND SEX DISPARITIES IN DEVELOPING HF, ITS SUBTYPES, AND ITS PROGNOSIS. THE HARMONIZED DATA WILL INCLUDE OVER 130,028 MEN AND WOMEN WITH OVER 8975 SIMILARLY-ADJUDICATED PROSPECTIVE HF OUTCOMES, REPRESENTING A WIDE SPECTRUM OF AGES, RACE/ETHNICITIES, AND GEOGRAPHIC REGIONS OF THE UNITED STATES. THIS CROSS-COHORT COLLABORATION WILL PROVIDE A UNIQUE OPPORTUNITY TO CONDUCT A COMPREHENSIVE EVALUATION OF SEX AND RACIAL/ETHNIC HEALTH DISPARITIES IN HF. CAUSAL MEDIATION ANALYSIS TECHNIQUES WILL BE USED TO ESTIMATE THE DEGREE TO WHICH SINGLE AND MULTI-FACTOR LIFESTYLE AND CLINICAL INTERVENTIONS COULD POTENTIALLY REDUCE HEALTH DISPARITIES IN HF. IN OUR PHENOMAPPING AIM, WE WILL DEFINE UNIQUE CLINICALLY RELEVANT PHENOTYPES OF HF BASED UPON COHORT DATA THAT IS ALSO COMMONLY PRESENT IN MEDICAL RECORDS FOR ENHANCED GENERALIZABILITY, INCLUDING AGE, RACE/ETHNICITY, SEX, CLINICAL SIGNS, SYMPTOMS, BIOMARKERS, EJECTION FRACTION, PHYSIOLOGIC MEASURES, AND CO-MORBIDITIES; WE WILL ALSO EVALUATE HF PHENOTYPE ASSOCIATIONS WITH CVD AND ALL-CAUSE MORTALITY.

RESIDENCY TRAINING IN PRIMARY CARE

PRIMARY CARE TRAINING AND ENHANCEMENT -- RESIDENCY TRAINING IN STREET MEDICINE - DESCRIPTION: THE KENT/BROWN FAMILY MEDICINE RESIDENCY IS LOCATED IN A HEALTH PROFESSIONALS SHORTAGE AREA IN PAWTUCKET, RI. THE PURPOSE OF OUR PROPOSED INITIATIVE IS TO ENHANCE THE CURRICULAR AND CLINICAL TRAINING EXPERIENCES OF: FAMILY MEDICINE (FM) RESIDENTS, FM FACULTY, INTERPROFESSIONAL (MENTAL HEALTH/BEHAVIORAL HEALTH, MEDICAL AND PHARMACY STUDENTS TRAINING TOGETHER IN THE FAMILY CARE CENTER; AND OTHER PRIMARY CARE PROVIDERS (PCPS) IN RI. WE AIM TO CULTIVATE A WORKFORCE OF PCPS WHO ARE: WELL PREPARED TO ADDRESS THE COMPREHENSIVE HEALTH CARE NEEDS OF PEOPLE EXPERIENCING HOMELESSNESS AND ESPECIALLY THOSE WITH SUBSTANCE USE AND MENTAL HEALTH DISORDERS; WELL VERSED IN COMMUNITY OUTREACH STRATEGIES TO DELIVER PATIENT-CENTERED, EVIDENCE-BASED CARE TO THOSE WITH LIMITED ACCESS; AND WHO WILL CONTINUE TO CARE FOR PEOPLE EXPERIENCING HOMELESSNESS UPON GRADUATION. NEEDS TO BE ADDRESSED: OUR INITIATIVE ADDRESSES KEY HRSA PRIORITIES BY DEVELOPING A STREET MEDICINE TRACK. IT ALSO RESPONDS TO HEALTH NEEDS IN RHODE ISLAND. THEY INCLUDE TRAINING FUTURE/CURRENT FAMILY PHYSICIANS AND OTHER PCPS TO 1) DELIVER PRIMARY CARE FOR PEOPLE EXPERIENCING HOMELESSNESS; 2) DEVELOP ADVANCED SKILLS TO ADDRESS THE BEHAVIORAL NEEDS OF PEH INCLUDING TO TREAT OPIOID USE DISORDER AND SUBSTANCE USE DISORDER; 3) WORK IN INTRADISCIPLINARY TEAMS TO PROVIDE COMPREHENSIVE CARE THAT ALSO ADDRESSES SOCIAL DETERMINANTS OF HEALTH. TRAINEE SPECIFIC OBJECTIVES TO BE ACCOMPLISHED: ANTICIPATED OUTCOMES FOR YEARS 2 – 5: 80% FM GRADUATES WILL PRACTICE IN PRIMARY CARE 50% FM GRADUATES WILL PRACTICE IN UNDERSERVED AREAS 20% FM GRADUATES WILL PRACTICE IN RURAL AREAS 20% FM GRADUATES WILL PARTICIPATE IN STREET MEDICINE 100% OF FM GRADUATES AND FM FACULTY WILL GAIN EXPERIENCE IN STREET MEDICINE TWO FM GRADUATES/YEAR WILL COMPLETE THE NEWLY ESTABLISHED STREET MEDICINE TRACK 75% OF FM GRADUATES AND 150 RI PCPS WILL PARTICIPATE IN ECHO/TELEMENTORING ACTIVITIES HOW PROJECT WILL BE ACCOMPLISHED: WE WILL DESIGN, IMPLEMENT AND EVALUATE A NEW STREET MEDICINE TRACK IN PARTNERSHIP WITH THE BROAD STREET CLINIC, THE RI STREET MEDICINE ORGANIZATION AS WELL AS PROJECT WEBER RENEW AND HOUSE OF HOPE. IN ADDITION, WE WILL DESIGN, IMPLEMENT AND EVALUATE NEW CURRICULA AND CLINICAL SERVICES AIMED AT BUILDING OUR PRIMARY CARE TRAINEES’ CAPACITY TO TREAT OPIOID USE DISORDER AND SUBSTANCE USE DISORDER IN PEH. THE KENT/BROWN FM RESIDENCY, STRENGTHENED BY ITS PARTNERSHIP WITH BROWN UNIVERSITY’S WARREN ALPERT MEDICAL SCHOOL AND MULTIPLE COMMUNITY PARTNERS, HAS A LONG TRACK RECORD OF EDUCATIONAL LEADERSHIP AND SUCCESSFUL IMPLEMENTATION OF INNOVATIVE PROGRAMS FOR PREPARING PCPS TO ADDRESS THE CHANGING HEALTH CARE NEEDS OF ALL POPULATIONS, WITH A FOCUS ON THE CARE OF UNDERSERVED COMMUNITIES. POPULATION GROUPS TO BE SERVED: RI HAS THE SECOND HIGHEST RATE OF HOMELESSNESS IN THE COUNTRY, A HIGH RATE OF OUD, AND IS WITHOUT A TARGETED PLAN TO IMPROVE PRIMARY CARE TO THESE POPULATIONS IN THE FUTURE. OUR INITIATIVE RESPONDS DIRECTLY TO THE POSSIBLE DRIVERS OF GAPS IN SERVICES AND WORKFORCE IN OUR STATE, WHILE AT THE SAME TIME HOLDING RELEVANCE FOR ONGOING CHANGE WITHIN REGIONAL AND NATIONAL HEALTH CARE DELIVERY SYSTEMS.

HEALTH CARE AND OTHER FACILITIES

HEALTH CARE FACILITIES AND OTHER CONSTRUCTION