COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP): A study protocol.
COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP): A study protocol.
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DOI：
10.1097/md.0000000000023680
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发表时间：
2021-02-05
期刊：
影响因子：
1.6
通讯作者：
Sabin J
中科院分区：
文献类型：
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作者：
Tjia J;Pugnaire M;Calista J;Esparza N;Valdman O;Garcia M;Yazdani M;Hale J;Terrien J;Eisdorfer E;Zolezzi-Wyndham V;Chiriboga G;Rappaport L;Puerto G;Dykhouse E;Potts S;Sifuentes AF;Stanhope S;Allison J;Duodo V;Sabin J
医疗保健专业人员对少数民族和贫困患者有负面的隐性偏见。很少有沟通技能干预措施将内隐偏见作为导致健康结果差异的一个因素。我们报告的协议，从COmmuNity-engaged模拟培训血压控制（CONSULT-BP），一项试验，评估一种新的教育和培训干预，针对毕业的医疗和护理实习生，旨在减轻临床遭遇的隐性偏见的影响。CONSULT-BP干预结合了知识获取、偏见意识和偏见缓解技能的实践，这些技能是在与不同种族/民族的标准化患者进行基于模拟的沟通时获得的。该试验评估了这3部分计划对患者BP结局、患者自我报告的药物依从性、患者报告的提供者沟通质量和学员偏见意识的影响。我们正在一个单一的学术医疗中心进行一项针对内科（IM）、家庭医学（FM）和执业护士（NP）学员的干预队列的群集随机试验。我们正在招募IM，FM和NP学员的整个专业队列，为期3年，每个学年构成一个干预周期。有3个实施周期对应于3个连续学年。在每个学年内，我们使用阶梯楔形设计将培训时间随机分配到5个开始日期中的1个。阶梯式楔形设计比较了干预前后训练组内的结果，以及暴露组和未暴露组之间的结果。血压控制的主要结果是在患者水平上测量的患者聚集在学员。结局分析的合格患者包括：讲英语的患者;非白人少数种族/民族;医疗补助接受者（不考虑种族/民族）;高血压患者;未患有妊娠、痴呆、精神分裂症、双相情感障碍或其他可能干扰高血压自我控制的严重合并症;未入组临终关怀。次要结果包括受训者的偏见意识。这项试验的一个独特之处是学术界和社区利益相关者参与设计，试点测试和实施针对医疗保健的培训计划。为临床医生提供技能，以减轻临床遭遇中的隐性偏见，对于解决医疗结果中的持续差异至关重要。我们的新的综合方法可以改善患者的预后。NCT 03375918 1.0（2020年11月10日）
Healthcare professionals have negative implicit biases toward minority and poor patients. Few communication skills interventions target implicit bias as a factor contributing to disparities in health outcomes. We report the protocol from the COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP), a trial evaluating a novel educational and training intervention targeting graduate medical and nursing trainees that is designed to mitigate the effects of implicit bias in clinical encounters. The CONSULT-BP intervention combines knowledge acquisition, bias awareness, and practice of bias mitigating skills in simulation-based communication encounters with racially/ethnically diverse standardized patients. The trial evaluates the effect of this 3-part program on patient BP outcomes, self-reported patient medication adherence, patient-reported quality of provider communication, and trainee bias awareness. We are conducting a cluster randomized trial of the intervention among cohorts of internal medicine (IM), family medicine (FM), and nurse practitioner (NP) trainees at a single academic medical center. We are enrolling entire specialty cohorts of IM, FM, and NP trainees over a 3-year period, with each academic year constituting an intervention cycle. There are 3 cycles of implementation corresponding to 3 sequential academic years. Within each academic year, we randomize training times to 1 of 5 start dates using a stepped wedge design. The stepped wedge design compares outcomes within training clusters before and after the intervention, as well as across exposed and unexposed clusters. Primary outcome of blood pressure control is measured at the patient-level for patients clustered within trainees. Eligible patients for outcomes analysis are: English-speaking; non-White racial/ethnic minority; Medicaid recipient (regardless of race/ethnicity); hypertension; not have pregnancy, dementia, schizophrenia, bipolar illness, or other serious comorbidities that would interfere with hypertension self-control; not enrolled in hospice. Secondary outcomes include trainee bias awareness. A unique feature of this trial is the engagement of academic and community stakeholders to design, pilot test and implement a training program addressing healthcare. Equipping clinicians with skills to mitigate implicit bias in clinical encounters is crucial to addressing persistent disparities in healthcare outcomes. Our novel, integrated approach may improve patient outcomes. NCT03375918 1.0 (November 10, 2020)