The proposed K23 award include one of the first comprehensive, mixed method studies of racial disparities in medical care for non-Hispanic blacks (NHBs) and non-Hispanic whites (NHWs) with multiple sclerosis (MS) and will provide the necessary support for Dr. Bhattarai, an early stage investigator, to obtain mentorship and training to reach her LONG-TERM GOAL of becoming an independent researcher and leading expert in understanding and addressing racial disparities in MS. There is a great need for additional researchers like Dr. Bhattarai who are dedicated to this line of research considering that NHBs fare markedly worse outcomes than NHWs and recent studies have shown a higher incidence of MS in NHBs compared to NHWs. Although MS has long been considered to be a disease that largely affects NHWs, findings such as these are worrisome because less than 1% of the MS literature has focused on NHBs. Racial disparities in healthcare are pervasive and research on other patient populations reveals disparities that arise from lower quality of care. The proposed project will involve medical chart reviews of prospectively collected patient data at two leading MS Centers in the US to quantify disparities in (AIM 1) quality of health care of NHBs and NHWs and (AIM 2) patient adherence to recommended plan of MS care in NHBs and NHWs. A convergent parallel mixed method, cross-sectional design will be employed to better understand patient perspectives on the critical aspects of MS care for AIM 3, which will involve data collection using established quantitative measures of patient experience and satisfaction with MS care, in- depth patient interviews, and focus groups stratified by race. We expect this research to advance the current state of research on MS by delivering high-quality data on racial disparities in MS care, which will provide the rationale for future R01 proposals that will focus on the development of innovative solutions to address the inequities in the MS population. The proposed career development and research plan directly address the mission of the NIMHD: to reduce disparities and improve minority health and the NIH's initiative on workforce diversity. Dr. Bhattarai will leverage the unparalleled resources at the Johns Hopkins School of Medicine and the Bloomberg School of Public Health to meet her career development goals to: (1) attain advanced training in epidemiological, biostatistical, and mixed research methods; (2) develop expertise in understanding and addressing health disparities in the MS population; and (3) enhance scientific writing, oral presentation, and collaboration skills. Dr. Bhattarai has strategically assembled an exemplary mentorship team of Drs. Ellen Mowry, Lisa Cooper, and Mary Catherine Beach?world renowned experts in the areas of MS, racial health disparities, and patient-provider communication?and a carefully-selected training plan of research activities, didactics, formal coursework, and scientific engagements. These factors, joined with the first-class training environment at Johns Hopkins, make Dr. Bhattarai an ideal candidate who is well-positioned to succeed.
Multiple sclerosis (MS) has long been considered a disease that largely affects non-Hispanic whites (NHWs); however, recent data show the incidence of MS in non-Hispanic blacks (NHBs) is 50% higher than in NHWs. Moreover, despite the markedly worse disease outcomes that NHBs experience, less than 1% of the MS literature has focused on this population. The proposed research involves one of the first mixed method analyses of racial disparities in MS care in NHBs and NHWs, and our findings are expected to inform the development of innovative solutions to address the prevailing disparities in the MS population.