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，“临床医生因素”是五个关键因素之一， 美国国立卫生研究院和美国医学院确定的外科差异的决定因素， 2015年外科医生峰会。然而，很少有人知道外科医生的特点，谁提供高- 对种族和少数民族患者的优质护理，以及外科医生接受的教育和培训是否影响 手术差异。这些知识差距阻碍了制定干预措施的努力， 缩小外科治疗的差距。拟议的R 01项目将创建一个全面的、多层次的 数据库，包括有关患者、外科医生、外科医生就读的医学院的详细信息，以及 外科医生完成的住院医师计划，通过链接四个大型的，具有全国代表性的数据集：（1）医疗保险 数据，（2）由Doximity组装的综合医生数据库，（3）AAMC医学院数据库， （4）AMA Residency数据库。在目标1中，使用这个创新的数据集，我们将研究是否 外科护理（即，护理过程、患者结局和利用率）在黑人和西班牙裔之间存在差异 当患者与白色患者由相同外科医生使用多水平回归进行治疗时 模型在目标2中，我们将确定外科医生的个人特征（例如，年龄、性别、外科医生是否 讲英语以外的语言，接受治疗的少数种族/族裔患者的比例 [“少数族裔服务的外科医生”]），这与外科护理中的种族/民族差异有关。最后利用 AAMC收集的关于医学院和住院医师项目特点的信息， AMA，目标3将确定医学院的特点（例如，种族/族裔比例 少数民族教师/学生，国际学生的百分比，农村与城市地区的位置）， 驻留程序（例如，种族和少数民族教师/学生/病人的比例， 文化能力意识计划，非英语语言教学）与文化能力 从而改善少数民族患者接受的外科护理。R 01项目将 提供一个独特的机会，通过更好地了解差异的机制来推进该领域 与外科医生因素有关，并将确定外科医生、医学院和 住院医师项目导致了外科护理的不平等。这个项目将提供一个强有力的证据 制定干预措施的基础，如基于证据的文化能力计划和持续 医学教育，这可以有效地减少外科护理中的种族和民族差异。研究 团队由多名NIH资助的研究人员组成，他们在所有相关领域（卫生服务研究， 差异研究，外科教育和统计学）进行这项创新研究。拟定研究 与NIH少数民族健康和健康差异研究战略计划保持一致。

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.