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.

项目摘要 器官移植是终末期器官疾病的最佳治疗方法，可提高患者的生存率， 生活质量黑人患者的终末期器官疾病的发生率几乎是白色患者的三倍， 只有20%的器官移植受者移植选择过程在移植中心之间没有标准化， 因此，这一进程每一阶段的决策都有可能受到体制性种族主义的影响。此外，国家 移植数据收集和监测排除了移植选择过程。本提案的总体目标是 是识别、描述和干预由于卫生系统过程而发生的器官移植不公平现象 我们的中心假设是，对公平的关注不足， 在甄选过程的每一阶段推行原则是造成不公平获得器官机会的主要原因 移植该项目将量化移植选择过程（筛选， 评估和委员会决策）使用电子健康记录数据， 移植筛选、评估和委员会决策过程导致获得机会的总体不公平 移植、设计和试点一个工具包，以减少移植筛选、评估和委员会中的不公平现象。 决策过程。本研究的结果将阐明制度性种族主义在移植中的影响 在获得器官移植方面种族平等的制度和程序。研究以及额外的知识和技能 发展将成为候选人过渡到独立调查员学习的坚实基础 采取干预措施，克服造成器官移植不平等的体制偏见做法。