Characterizing Bias and Care Disparities with Physical Restraint Use in the Emergency Setting Using Natural Language and Cognitive Data

使用自然语言和认知数据描述紧急情况下使用身体约束的偏见和护理差异

• 批准号: 10431043
• 负责人: Ambrose H Wong
• 金额: $ 25.13万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-02 至 2024-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10431043
• 关键词: Accident and Emergency department; Address; Affect; Aggressive behavior; Agitation; Algorithms; Area; Artificial Intelligence; Asphyxia; Behavioral; Black race; Caring; Censuses; Cessation of life; Clinical; Coercion; Cognitive; Complement; Computers; Cross-Sectional Studies; Cues; Data; Data Element; Databases; Decision Making; Discipline; Discrimination; Electronic Health Record; Emergency Care; Emergency Department patient; Emergency Situation; Emergency department visit; Environment; Event; Focus Groups; Health Disparities Research; Health Personnel; Health Services Research; Health system; Healthcare Systems; Homelessness; Human; Individual; Informatics; Insurance; Interdisciplinary Study; Interpersonal Relations; Interview; Investments; Language; Lead; Maps; Measures; Mediating; Mediation; Mediator of activation protein; Methods; Minority; Minority Groups; Modeling; Natural Language Processing; Nurses; Patient Care; Patients; Physical Restraint; Physicians; Population; Population Analysis; Populations at Risk; Prevalence; Process; Psyche structure; Qualitative Methods; Research; Research Methodology; Risk; Risk Factors; Safety; Security; Structure; Substance Use Disorder; System; Techniques; Testing; Text; Therapeutic; Time; Training; Trauma; Trust; Ventilatory Depression; Violence; Visit; Work; analytical method; base; behavioral health; black patient; clinical decision-making; cognitive task; deep learning model; emergency settings; executive function; experience; health disparity; heuristics; high risk; innovation; interdisciplinary approach; low socioeconomic status; marginalized population; minority health disparity; natural language; novel; prevent; public health insurance; restraint; severe mental illness; social culture; socioeconomic disadvantage; structured data; task analysis; therapy development; tool

PROJECT SUMMARY Agitation is defined as excessive psychomotor activity leading to aggressive and violent behavior in patients. Those presenting with agitation in the emergency setting represent the most marginalized populations. Coercive measures like physical restraints are currently used routinely on agitated individuals, but are associated with physical trauma, respiratory depression, and death. Recent studies have shown disproportionate use of physical restraint on Black patients, those who are homeless, and those with public or no insurance. Identification of specific interpersonal and structural factors that affect heuristics and decision- making of healthcare workers regarding restraint use is needed to mitigate systemic bias and discrimination against these marginalized patients. However, current research is limited to analyzing structured quantitative data elements, while narrative text better reflects sociocultural contexts, interpersonal interactions, and clinician thought processes. Natural language processing is an informatics discipline that can parse free text within clinical notes into quantifiable variables on a large scale that can be combined with mediation analysis to uncover factors leading to disparities in restraint use. A complementary tool is cognitive task analysis, which uses qualitative methods to understand how mediators of bias affect clinical decision-making at the bedside. Our overall objective is to use the combination of these innovative analytical methods to overcome deficiencies of standard health service research methods in identifying individual, interpersonal, institutional, and systems factors leading to bias in physical restraint use. In Aim 1, we will use natural language processing and mediation analysis on a large database of emergency department clinical narrative notes across our regional healthcare system to extract and identify candidate variables that lead minority populations to increased risk of physical restraint. This will allow us to verify and test potential factors within our newly derived conceptual model of bias during restraint use that predict discriminatory practices. In Aim 2, we will use cognitive task analyses through qualitative interviews and video-informed focus groups with emergency healthcare workers to characterize drivers and cues that influence decision-making and heuristics against minority populations. This will complement the results from Aim 1 by providing explanatory models for how interpersonal and structural factors that lead to bias are manifested at the bedside. This proposed work will make a positive contribution to minority and health disparities research in the emergency setting by identifying specific interpersonal and structural factors mediating bias and discrimination against minority and socioeconomically disadvantaged individuals with behavioral emergencies. Our study is exploratory and novel as it combines innovative and multidisciplinary approaches from two complementary scientific fields to address multiple system levels of influence within the healthcare system in an understudied area for emergency care where significant harm is occurring for marginalized populations.

项目概要 激越被定义为导致患者出现攻击性和暴力行为的过度精神运动活动。 那些在紧急情况下情绪激动的人代表了最边缘化的人群。 目前，对易激动的个人通常使用身体约束等强制措施，但 与身体创伤、呼吸抑制和死亡有关。最近的研究表明 对黑人患者、无家可归者以及公共场所或公共场所的患者过度使用身体束缚 没有保险。识别影响启发式和决策的特定人际关系和结构因素 需要让医护人员了解约束的使用，以减轻系统性偏见和歧视 针对这些边缘化的患者。然而，目前的研究仅限于分析结构化定量 数据元素，而叙述文本更好地反映社会文化背景、人际互动和 临床医生的思维过程。自然语言处理是一门可以解析自由文本的信息学学科 在临床记录中转化为大规模的可量化变量，可以与中介分析相结合 揭示导致约束使用差异的因素。一个补充工具是认知任务分析，它 使用定性方法来了解偏倚调节因素如何影响床边的临床决策。 我们的总体目标是结合使用这些创新的分析方法来克服缺陷 识别个人、人际、机构和系统的标准卫生服务研究方法 导致身体约束使用偏差的因素。在目标 1 中，我们将使用自然语言处理 对我们地区的急诊科临床叙述笔记大型数据库进行中介分析 医疗保健系统提取和识别导致少数群体患病风险增加的候选变量 身体约束。这将使我们能够验证和测试新推导的概念中的潜在因素 预测歧视性做法的约束使用期间的偏见模型。在目标 2 中，我们将使用认知任务 通过定性访谈和视频焦点小组与紧急医护人员进行分析 描述影响少数群体决策和启发的驱动因素和线索。这 将通过提供关于人际和结构如何变化的解释模型来补充目标 1 的结果 导致偏差的因素在床边就显现出来。 这项拟议的工作将为少数民族和健康差异研究做出积极贡献 通过识别介导偏见和歧视的特定人际和结构因素来设置紧急情况 针对出现行为紧急情况的少数群体和社会经济弱势群体。我们的研究是 探索性和新颖性，因为它结合了两个互补的创新和多学科方法 科学领域，以在未充分研究的情况下解决医疗保健系统内的多个系统级别的影响 边缘人群遭受重大伤害的紧急护理区域。