Mitigating Structural Racism to Reduce Inequities in Sepsis Outcomes

项目摘要 脓毒症每年影响美国约170万患者，是死亡的主要原因之一， 是美国医疗保健成本的主要驱动因素。非裔美国人/黑人（AA/B）和拉丁裔人群 败血症并发症、标准治疗偏离以及全因和败血症的发生率更高 与非西班牙裔白色（NHW）人群相比，尽管有明确的证据表明 这种结构性种族主义在医院和社区层面上加剧了各种因素， AA/B和LatinX患者的护理和结局，没有基于证据的前瞻性干预措施， 命名和解决败血症护理中的结构性种族主义，我们也不知道有研究报告种族歧视减少， 脓毒症护理的不公平性。解决结构性种族主义对脓毒症护理的影响 需要卫生系统和社区机构采取集体行动， (e.g.,组织文化），以跨越历史、政治和组织边界进行有效协作。 我们之前的研究表明，基于联盟的领导力发展方法可以有效地 培养能够改善复杂健康结果的组织文化。我们建议调整、交付和 评估一项基于联盟的干预措施，使卫生系统及其周边社区能够 并解决结构性种族主义问题，推动败血症结果中的不平等现象得到可衡量的减少。我们的具体 目标是：（1）在美国八个卫生系统中适应并提供基于联盟的领导干预， 他们周围的社区，以改善需要命名和 解决结构性种族主义问题;（2）采用纵向、趋同的混合方法评估干预措施的影响， 方法的方法，以量化的变化，在域的组织文化，需要命名和 使用新型调查工具解决结构性种族主义问题并描述文化变革的经历 在每个系统内，在分析阶段综合定量和定性数据， 全面了解干预措施的影响和影响可能产生的机制 （3）评估干预措施对减少三个临床研究中种族不平等的影响。 结果：a）早期识别（使用抗生素的时间），B）临床管理（院内败血症死亡率）和c） 使用中断时间序列进行基于标准的随访（同一医院，全因脓毒症再入院） 分析和比较在文化领域实现有意义变化的系统的临床结局 需要与那些没有实现有意义变革的国家一道解决结构性种族主义问题。拟定研究 及时，高度相关，并与NIH和脓毒症联盟的行动呼吁完全一致， 败血症护理和结果的不公平性。它也具有很强的创新性，因为它将是第一个干预 前瞻性地通过发展组织文化领域， 反种族主义行动所需的信息，对败血症以外的复杂健康结果的不公平产生影响。

PROJECT ABSTRACT Sepsis affects approximately 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 (AA/B) and LatinX populations experience higher rates of sepsis complications, deviations from standard care, and all-cause and sepsis readmissions compared with Non-Hispanic White (NHW) populations. Despite clear evidence of the ways in which structural racism compounds factors at the hospital and community levels to generate poorer sepsis care and outcomes for AA/B and LatinX patients, there are no evidence-based, prospective interventions to name and address structural racism in sepsis care, nor are we aware of studies that report reductions in racial inequities in sepsis care as an outcome. Naming and addressing the impact of structural racism on sepsis care will require collective action across health systems and community institutions, supported by ways of working (e.g., organizational culture) to collaborate effectively across historical, political, and organizational boundaries. Our prior research has shown that coalition-based leadership development approaches can be effective in cultivating organizational culture that can improve complex health outcomes. We propose to adapt, deliver, and evaluate a coalition-based intervention to equip health systems and their surrounding communities to name and address structural racism and drive measurable reductions in inequities in sepsis outcomes. Our specific aims are to: (1) Adapt and deliver a coalition-based leadership intervention in eight U.S. health systems and their surrounding communities to improve domains of organizational culture that are required to name and address structural racism; (2) Evaluate the impact of the intervention using a longitudinal, convergent mixed methods approach to quantify change in domains of organizational culture that are required to name and address structural racism using a novel survey instrument and describe the experience of culture change within each system, integrating quantitative and qualitative data at the analysis phase in order to develop a comprehensive understanding of the intervention impact and mechanisms by which the impact may have occurred; 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 and comparing clinical outcomes from systems that achieved meaningful change in domains of culture required to address structural racism with those that did not achieve meaningful change. The proposed study is timely, highly relevant, and fully aligned with calls to action by the NIH and the Sepsis Alliance to address inequities in sepsis care and outcomes. It is also highly innovative, as it would be the first to intervene prospectively 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.