Mitigating structural racism to reduce inequities in sepsis outcomes: a mixed methods, longitudinal intervention study.
Mitigating structural racism to reduce inequities in sepsis outcomes: a mixed methods, longitudinal intervention study.
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DOI：
10.1186/s12913-022-08331-5
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发表时间：
2022-07-30
影响因子：
2.8
通讯作者：
Curry, Leslie A.
中科院分区：
文献类型：
--
作者：
Linnander, Erika L.;Ayedun, Adeola;Boatright, Dowin;Ackerman-Barger, Kupiri;Morgenthaler, Timothy, I;Ray, Natasha;Roy, Brita;Simpson, Steven;Curry, Leslie A.
关键词：
败血症每年影响美国170万患者，是导致死亡的主要原因之一，也是美国医疗费用的主要驱动因素。与非西班牙裔白人相比，非裔美国人/黑人和拉丁裔人群经历了更高的脓毒症并发症、偏离标准护理和重新入院的比率。尽管有明确的证据表明败血症护理中的结构性种族主义和结果，但没有前瞻性的干预措施来减轻脓毒症护理中的结构性种族主义，我们也不知道有研究报告败血症护理中的种族不平等现象有所减少。因此，我们将提供和评估一项以联盟为基础的干预措施，以装备卫生系统及其周围社区，以减轻结构性种族主义，推动败血症结果中的不平等现象显著减少。本文介绍了研究的理论基础，总结了干预的关键要素，并描述了评估干预的方法。我们的目标是：(1)在美国八个卫生系统及其周边社区实施以联盟为基础的领导干预；(2)使用纵向、趋同的混合方法评估干预对组织文化的影响，以及(3)评估干预对减少三种临床结果中种族不平等的影响：a)早期识别(使用抗生素的时间)，b)临床管理(医院内败血症死亡率)和c)使用中断时间序列分析基于标准的随访(同一家医院，所有原因的败血症再住院)。这项研究与美国国立卫生研究院和脓毒症联盟呼吁采取行动，解决脓毒症护理和结局中的不平等问题保持一致。它是第一个采取干预措施，通过发展反种族主义行动所需的组织文化领域来减轻结构性种族主义的影响，这对脓毒症以外的复杂健康后果中的不平等产生了影响。网上版载有补充材料，可在10.1186/s12913-022-08331-5查阅。
Sepsis affects 1.7 million patients in the US annually, is one of the leading causes of mortality, and is a major driver of US healthcare costs. African American/Black and LatinX populations experience higher rates of sepsis complications, deviations from standard care, and readmissions compared with Non-Hispanic White populations. Despite clear evidence of structural racism in sepsis care and outcomes, there are no prospective interventions to mitigate structural racism in sepsis care, nor are we aware of studies that report reductions in racial inequities in sepsis care as an outcome. Therefore, we will deliver and evaluate a coalition-based intervention to equip health systems and their surrounding communities to mitigate structural racism, driving measurable reductions in inequities in sepsis outcomes. This paper presents the theoretical foundation for the study, summarizes key elements of the intervention, and describes the methodology to evaluate the intervention. Our aims are to: (1) deliver a coalition-based leadership intervention in eight U.S. health systems and their surrounding communities; (2) evaluate the impact of the intervention on organizational culture using a longitudinal, convergent mixed methods approach, and (3) evaluate the impact of the intervention on reduction of racial inequities in three clinical outcomes: a) early identification (time to antibiotic), b) clinical management (in-hospital sepsis mortality) and c) standards-based follow up (same-hospital, all-cause sepsis readmissions) using interrupted time series analysis. This study is aligned with calls to action by the NIH and the Sepsis Alliance to address inequities in sepsis care and outcomes. It is the first to intervene to mitigate effects of structural racism by developing the domains of organizational culture that are required for anti-racist action, with implications for inequities in complex health outcomes beyond sepsis. The online version contains supplementary material available at 10.1186/s12913-022-08331-5.
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DOI：
10.1161/circoutcomes.116.003422
发表时间：
2017-03-01
影响因子：
6.9
作者：
Bradley, Elizabeth H.;Brewster, Amanda L.;Curry, Leslie A.
通讯作者：
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影响因子：
4.8
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影响因子：
5.7
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影响因子：
9.7
作者：
Brown, Elizabeth J.;Polsky, Daniel;Grande, David
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Grande, David