The Impact of Surgeon Factors and Education/Training on Disparities in Surgical Care.

项目摘要 有证据表明，接受手术的种族和少数民族患者得到的护理质量较差， 在美国，经历比白人患者更糟糕的结果。“临床医生因素”是五大关键因素之一 美国国立卫生研究院和美国国立卫生研究院确定的外科差异的决定因素 2015年外科医生峰会。然而，人们对外科医生的特点知之甚少。 对少数族裔患者的优质护理，以及教育和培训外科医生是否受到影响 外科手术的差异。这些知识差距阻碍了制定有效的干预措施 缩小外科护理方面的差距。建议的R01项目将创造一个全面的、多层次的 数据库，包括患者、外科医生、医学院外科医生的详细信息，以及 住院医师计划外科医生通过链接四个具有全国代表性的大型数据集完成：(1)联邦医疗保险 数据，(2)Doximity汇编的综合医生数据库，(3)AAMC医学院数据库， 以及(4)AMA常驻人员数据库。在目标1中，使用这个创新的数据集，我们将检查 外科护理(即护理过程、患者结果和使用)在黑人和西班牙裔之间有所不同 同一外科医生治疗的患者与白人患者的多水平回归分析 模特们。在目标2中，我们将确定外科医生的个人特征(例如，年龄、性别、是否外科医生 会说英语以外的语言，以及接受治疗的患者中种族/少数民族的比例 [“为少数群体服务的外科医生”])与外科护理方面的种族/民族差异有关。最后，使用 AAMC和AAMC收集的关于医学院和实习项目的特点的信息 AMA，Aim 3将确定医学院的特点(例如，种族/民族比例 少数族裔教职员工/学生、国际学生的百分比、农村地区与城市地区的地点)和 住院方案(例如，少数族裔和少数民族教职员工/学生/患者的比例、 文化能力意识计划、非英语语言教学)与文化能力有关 改善种族和少数民族患者接受的外科治疗。拟议的R01项目将 提供了一个独特的机会，通过更好地了解差异的机制来推动该领域的发展 与外科医生因素相关，并将确定外科医生、医学院和 住院医师计划造成外科护理方面的差异。这一项目将提供强有力的证据 制定干预措施的基础，如基于证据的文化能力方案和继续 医学教育，这可以有效地减少外科治疗中的种族和民族差异。这项研究 团队由多名NIH资助的研究人员组成，他们拥有所有相关领域的专业知识(卫生服务研究， 差异研究、外科教育和统计学)来进行这项创新研究。建议进行的研究 与美国国立卫生研究院研究少数群体健康和健康差距的战略计划很好地一致。

Project Summary Evidence indicates that racial and ethnic minority patients undergoing surgery receive worse quality care and experience worse outcomes than White patients do in the U.S. “Clinician factors” are one of five key determinants of surgical disparities identified at the National Institutes of Health and American College of Surgeons Summit in 2015. However, little is known about the characteristics of surgeons who deliver high- quality care to racial and ethnic minority patients, and whether education and training surgeons received affect surgical disparities. These knowledge gaps have hindered efforts to develop interventions that can effectively close the disparity gap in surgical care. The proposed R01 project will create a comprehensive, multi-level database that includes detailed information about patients, surgeons, medical schools surgeons attended, and residency programs surgeons completed, by linking four large, nationally-representative datasets: (1) Medicare data, (2) comprehensive physician database assembled by Doximity, (3) the AAMC Medical School database, and (4) the AMA Residency database. In Aim 1, using this innovative dataset, we will examine whether surgical care (i.e., processes of care, patient outcomes, and utilizations) differ between Black or Hispanic patients versus White patients when they are treated by the same surgeons using multi-level regression models. In Aim 2, we will identify individual characteristics of surgeons (e.g., age, gender, whether surgeons speak languages other than English, and the proportion of patients treating who are racial/ethnic minorities [“minority-serving surgeons”]) that are associated with racial/ethnic disparities in surgical care. Finally, using the information on the characteristics of medical schools and residency programs collected by AAMC and AMA, Aim 3 will determine whether the characteristics of medical schools (e.g., the proportion of racial/ethnic minority faculty/students, the percentage of international students, location in rural vs. urban areas) and residency programs (e.g., the proportion of racial and ethnic minority faculty/students/patients, the presence of cultural competence awareness program, instruction in non-English languages) related to cultural competency lead to improved surgical care received by racial and ethnic minority patients. The proposed R01 project will provide a unique opportunity to advance the field by better understanding the mechanisms of disparities related to surgeon factors, and will identify potentially modifiable attributes of surgeons, medical schools, and residency programs that contribute to disparities in surgical care. This project will provide a strong evidence base for developing interventions, such as evidence-based cultural competency programs and Continuing Medical Education, which can effectively reduce racial and ethnic disparities in surgical care. The research team consists of multiple NIH-funded researchers with expertise in all relevant fields (health services research, disparity research, surgical education, and statistics) to conduct this innovative research. The proposed study aligns well with the NIH strategic plan for research in minority health and health disparities.