Improving Racial Equity in Clinical Decision Making about Access to Organ Transplant

改善器官移植临床决策中的种族平等

• 批准号: 10507407
• 负责人: Lisa M McElroy
• 金额: $ 13.17万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10507407
• 关键词: Attention; Black race; Cessation of life; Clinical; Cross-Sectional Studies; Data; Data Collection; Decision Making; Diagnostic tests; Disease; Educational Background; Electronic Health Record; Ethnic Origin; Evaluation; Focus Groups; Foundations; Funding; Future; Gender; Geography; Goals; Health system; Individual; Institutional Racism; Insurance Coverage; Intervention; Intervention Studies; Knowledge; Lead; Measures; Mediator of activation protein; Medicine; Mentors; Methods; Monitor; Nurses; Operative Surgical Procedures; Organ; Organ Transplantation; Outpatients; Patients; Persons; Phase; Plant Roots; Process; Quality of life; Race; Racial Equity; Research; Research Personnel; Social Work; Standardization; Surveys; System; Testing; Time; Training; Transplant Recipients; Transplantation; Transportation; United States; Waiting Lists; Work; acceptability and feasibility; black patient; clinical application; clinical decision-making; clinical practice; design; ethnic minority; improved; income insurance; meetings; multidisciplinary; optimal treatments; organ transplant recipient; patient screening; racial bias; racial disparity; racial minority; screening; skill acquisition; social health determinants; tool; transplant centers

PROJECT SUMMARY Organ transplantation is the optimal treatment for end stage organ disease and results in improved patient survival and quality of life. Black patients have rates of end stage organ disease nearly three times that of white patients, yet comprise only 20% of organ transplant recipients. The transplant selection process is not standardized across transplant centers and therefore decision making at each phase of the process is potentially vulnerable to institutional racism. Further, national transplant data collection and monitoring exclude the transplant selection process. The overall objective of this proposal is to identify, characterize, and intervene on inequities in organ transplant that occur due to health system processes which are vulnerable to interpersonal and institutional bias Our central hypothesis is that inadequate attention to equity promoting principles throughout each phase of the selection process are major contributors to inequitable access to organ transplant. This project will quantify racial inequities at each phase of the transplant selection process (screening, evaluation and committee decision making) using electronic health record data, characterize vulnerabilities in the transplant screening, evaluation and committee decision aming processes that contribute to overall inequities in access to transplant and design and pilot a toolkit to reduce inequities in the transplant screening, evaluation and committee decision making processes. This results of this project will elucidate the influence of institutional racism in transplant systems and processes on racial equity in access to transplant. The research and additional knowledge and skill development will form a strong foundation for the candidate’s transition to an independent investigator studying interventions to overcome institutionally biased practices which contribute to organ transplant inequities.

项目总结 器官移植是终末期器官疾病的最佳治疗方法，可提高患者的存活率和 生活质量。黑人患者的终末期器官疾病发病率几乎是白人患者的三倍，但包括 只有20%的器官移植接受者。移植选择过程在不同的移植中心并不标准化 因此，这一进程每个阶段的决策都可能容易受到体制种族主义的影响。更进一步，全国性的 移植数据收集和监测不包括移植选择过程。这项提案的总体目标是 是识别、描述和干预由于卫生系统过程而导致的器官移植中的不平等现象 容易受到人际和制度偏见的影响我们的中心假设是，对公平的关注不足 在选择过程的每个阶段宣传原则是造成不公平获得器官的主要原因 移植。该项目将量化移植选择过程每个阶段的种族不平等(筛查， 评估和委员会决策)使用电子健康记录数据，表征 器官移植筛查、评估和委员会决策过程，造成了获取方面的总体不平等 移植、设计和试点工具包，以减少移植筛查、评估和委员会中的不公平现象 决策过程。这一项目的结果将阐明制度性种族主义对移植的影响 关于移植机会中种族公平的制度和程序。研究和其他知识和技能 发展将为候选人过渡到独立调查员研究奠定坚实的基础 采取干预措施，克服导致器官移植不公平的制度性偏见做法。