Racial Differences in Treatment with Hysterectomy: a Multilevel Investigation

子宫切除术治疗的种族差异：多层次调查

• 批准号: 10196944
• 负责人: Whitney Ragan Robinson
• 金额: --
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-26 至 2021-09-06
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10196944
• 关键词: Affect; Anemia; Automobile Driving; Bilateral; Caring; Clinical; Complex; Computerized Medical Record; Data; Decision Making; Disease; Ensure; Ethnic Origin; Excision; Goals; Gynecologic; Gynecologic Surgical Procedures; Health; Health system; Healthcare; Healthcare Systems; High Prevalence; Hispanics; Hospitals; Hysterectomy; Infertility; Institution; Investigation; Literature; Long-Term Effects; Malignant neoplasm of ovary; Mammalian Oviducts; Measures; Medical; Medical Records; Menopausal Symptom; Minority; Operative Surgical Procedures; Ovarian; Ovary; Pain; Patients; Pattern; Positioning Attribute; Premenopause; Prevalence; Provider; Ptosis; Quality of life; Race; Research; Sampling; Secondary to; Severities; Stroke; Surgical complication; Symptoms; System; Testing; Time; Tubal Excisions; Uterine Fibroids; Uterus; Variant; Weight; Woman; Work; aged; alternative treatment; black women; cancer risk; endometriosis; ethnic difference; experience; health care disparity; improved; innovation; middle age; mortality; patient oriented; practice factors; racial and ethnic; racial and ethnic disparities; racial difference; reproductive; surgical disparities; treatment effect

1 PROJECT SUMMARY/ABSTRACT 2 3 Every year, millions of U.S. women must decide whether to have their uteri removed to treat painful and 4 incapacitating gynecologic disorders, such as uterine fibroids, endometriosis, and prolapse. Unfortunately, 5 decisions about hysterectomy may be influenced as much by a woman's race as by objective clinical 6 indications. Despite hysterectomy's prevalence, little is known about how these surgery decisions are made: 7 the existing literature is limited by non-generalizable single-institution studies, racially homogenous samples, 8 inadequate control for symptom severity, and inability to measure the influences of the culture of the healthcare 9 system. The long-term goal of this proposal is to ensure that women of all backgrounds are treated in an 10 equitable manner when it comes to hysterectomy decision-making. To achieve this goal, the objectives of this 11 application are to understand where racial differences in treatment with gynecologic surgery arise and to 12 evaluate the extent to which racial/ethnic differences in hysterectomy treatment constitute surgical disparities. 13 The central hypothesis is that clinical severity will not fully account for all racial/ethnic differences in 14 hysterectomy treatment. We hypothesize that provider-level and practice-level clinical culture can impede 15 equitable dissemination of surgical innovations in hysterectomy. The rationale for the proposed research is that 16 identifying multilevel health care-system influences on hysterectomy receipt will help identify the best targets 17 on which to intervene to achieve equitable surgical care of women's gynecologic conditions. The hypotheses 18 will be tested by pursuing three specific aims: 1) Determine the extent to which the clinical threshold for 19 hysterectomy (uterine weight, pre-operative anemia, pre-operative pain) varies by race/ethnicity; 2) Quantify 20 the extent to which minority patients are differentially likely to be treated by low-volume providers and by 21 practices with high propensity to perform hysterectomy; and 3) Identify drivers of the dissemination of bilateral 22 salpingectomy with ovarian retention (BSOR) at the time of hysterectomy and the extent to which this 23 dissemination varied by race/ethnicity. This approach is innovative because it directly evaluates the 24 longstanding but untested hypothesis that racial differences in clinical severity explain differences in 25 hysterectomy rates. The work also employs an innovative multilevel framework including provider- and 26 practice-level factors. Finally, the work investigates how surgical culture can facilitate or impede the 27 dissemination of a cancer risk-reducing surgical innovation. This work will have sustained impact because it 28 goes beyond documenting racial differences: when this work is completed, we will understand what disparities 29 exist but also how these differences arise. Gynecologic problems are under-investigated relative to their high 30 prevalence, impact on quality of life, and long-term effects of treatment on the health of tens of millions of U.S. 31 women. Fortunately, hysterectomy is both common and amenable to change; therefore, identifying targets to 32 improve equity in the surgery can exert a powerful influence on the gynecologic surgery field. 33 1

1个项目摘要/摘要 2. 每年，数以百万计的美国妇女必须决定是否切除她们的子宫以治疗疼痛和 4致残妇科疾病，如子宫肌瘤、子宫内膜异位症、脱垂。不幸的是， 关于子宫切除的决定可能既受客观临床因素的影响，也受女性种族的影响 6个适应症。尽管子宫切除术很普遍，但人们对这些手术决定是如何做出的知之甚少： 7现有文献受限于不可概括的单一机构研究、种族同质样本、 8对症状严重程度的控制不足，无法衡量医疗保健文化的影响 9系统。这项提案的长期目标是确保所有背景的妇女在 10当涉及到子宫切除决策时，要以公平的态度。为了实现这一目标，这一目标 11项申请是为了了解妇科手术治疗中存在种族差异的地方，并 12评估子宫切除治疗中的种族/族裔差异在多大程度上构成手术差异。 13中心假设是，临床严重性不能完全解释所有种族/民族差异。 14行子宫切除术。我们假设提供者级别和实践级别的临床文化可能会阻碍 15公平传播子宫切除术中的手术创新。建议进行这项研究的理由是 16确定多层次卫生保健系统对子宫切除术收治的影响将有助于确定最佳目标 17对此进行干预，以实现对妇女妇科疾病的公平外科治疗。假说 18将通过追求三个具体目标进行测试：1)确定临床阈值 19.子宫切除术(子宫重量、术前贫血、术前疼痛)因种族/民族而异；2)量化 20少数族裔患者在多大程度上有可能由低容量提供者和由 有高倾向进行子宫切除术的21种做法；以及3)确定双边传播的驱动因素 22子宫切除时输卵管切除伴卵巢保留(BSOR)及其程度 23传播情况因种族/族裔而异。这种方法是创新的，因为它直接计算 24个长期存在但未经检验的假说，即临床严重程度的种族差异可以解释 子宫切除率为25。这项工作还采用了一个创新的多层次框架，包括提供商和 26个实践性因素。最后，这项工作调查了外科文化如何促进或阻碍 27日传播了一项降低癌症风险的外科创新。这项工作将产生持久的影响，因为 28不仅仅是记录种族差异：当这项工作完成时，我们将了解什么是差异 29的存在，以及这些差异是如何产生的。相对于他们的高水平，妇科问题被低估了 30患病率、对生活质量的影响以及治疗对数千万美国人健康的长期影响。 31名女性。幸运的是，子宫切除术既常见又容易改变；因此，确定目标是 32提高手术公平性可以对妇科手术领域产生强大的影响。 33 1