My proposal seeks to evaluate the biosocially complex interaction between heart failure (HF) patients and health system to guide evidence-based interventions to improve wellbeing for patients in low- and middle-income countries (LMIC). In Haiti, HF is the leading cause of internal medicine hospitalization. However, only 45% of patients from the catchment area of a rural hospital are linked to clinic within 30 days of discharge, highlighting the need for improved care systems.My long-term goal is to develop into an independent clinician scientist with expertise in health service delivery research. The objective of my application is to elucidate the facilitators and barriers of linkage to outpatient care for HF patients hospitalized in rural Haiti by combining qualitative and quantitative methods in a sequential mixed methods design. The proposed research will be conducted in rural Haiti in collaboration with the non-governmental organizations Partners In Health and Zanmi Lasante to achieve the following specific aims under the guidance of the multidisciplinary team of mentors:Aim 1: Identify facilitators and barriers to linkage to care for HF management perceived by patients and healthcare providers through qualitative data. We will perform interviews and focus group discussions involving 24-30 patients (stratified by those who are/are not linked) and 12-15 providers. Through comparison of the themes endorsed between and among patient groups, we will generate and refine hypotheses about key mediators and barriers that will be tested with subsequent quantitative study data. Hypothesis 1 (provisional): High health-related costs and competing priorities are barriers to care seeking among patients.Aim 2: Quantitatively identify patient and health system level risk factors for poor linkage to care using multivariable logistic regression. In a prospective cohort of n=400 HF patients discharged from HUM over 2-years, baseline data (informed by Aim 1) will be collected. Hypothesis 2: A priori, combinations of patient and health system features inhibit linkage to care. The specific hypothesis will be refined using Aim 1.
|Program type||Mentored Clinical & Population Research Program|
|Effective start/end date||01/01/2017 → 12/31/2018|