PAINED: Project Addressing INequities in the Emergency Department

痛苦：解决急诊科不公平问题的项目

• 批准号: 10537743
• 负责人: Monika Kumari Goyal
• 金额: $ 176.61万
• 依托单位: CHILDREN'S RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10537743
• 关键词: Absence of pain sensation; Accident and Emergency department; Acute Pain; Address; Age; Appendicitis; Awareness; Care given by nurses; Caring; Child; Child Health; Clinical; Data; Discipline of Nursing; Documentation; Electronic Health Record; Emergency department visit; Ethnic Origin; Evaluation; Evidence based intervention; Feedback; Foundations; Fracture; Goals; Guidelines; Health; Health Services Accessibility; Healthcare Systems; Helping to End Addiction Long-term; Implicit Association Test; Information Technology; Interruption; Intervention; Measures; Nurses; Opioid Analgesics; Outcome; Outcome Measure; Pain Measurement; Pain management; Parents; Pathway interactions; Patients; Performance; Phase; Physicians; Process; Process Measure; Prospective Studies; Provider; Quality of Care; Race; Reporting; Research; Research Design; Role; Socioeconomic Status; Testing; Time; Time Series Analysis; Unconscious State; Work; base; behavior change; care delivery; care seeking; clinical care; clinical decision support; clinical encounter; health care delivery; health care disparity; health care quality; health difference; health equity; health inequalities; implicit bias; improved; innovation; long bone; pain reduction; pain score; patient oriented; patient population; pediatric emergency; racial and ethnic; racial and ethnic disparities; response; simulation; stem; success; support tools

Project Abstract Racial and ethnic inequities in health care quality have been described across a broad range of clinical settings, patient populations, and outcomes. Clinician implicit bias has been implicated in the causal pathway for health care disparities. It is now imperative that we target the causes and develop interventions to mitigate and eradicate such inequities. Our overarching goal is to eradicate health care inequities through evidence- based interventions. In response to the RFA-NS-22-002: HEAL Initiative: Advancing Health Equity in Pain Management (R61/R33), the objectives of this proposal are to develop and test the impact of two interventions on overcoming clinician implicit bias and mitigating inequities in the management of pain among children seeking care in the emergency department for the treatment of appendicitis or long bone fractures. The scientific premise stems from our prior work which: 1) demonstrated racial and ethnic inequities in the management of pain for children in the emergency department; 2) examined the role of implicit bias in vignette- based health outcomes; and 3) used audit and feedback and clinical decision support tools to improve performance metrics among clinicians. We will build on this foundational work by measuring the impact of clinician implicit bias among providers and nurses on both process and outcome measures, including the assessment and reduction of pain. We will use a stakeholder-informed approach to identify quality metrics that are patient-centric. We will then test whether regular clinician audit and feedback, through the provision of ‘Equity Report Cards,’ as well as provision of real-time, electronic health record-embedded clinical decision support can serve as useful interventions in mitigating racial/ethnic disparities in clinical outcomes. This research is significant because both interventions can be inexpensively disseminated and scaled to emergency departments nationally as well as to other clinical venues and adapted for various clinical conditions. Through innovative study design and rigorous evaluation, this proposal will provide critical evidence and lay the foundation for eradicating racial and ethnic inequities in the provision of care and improved child health outcomes for all.

项目摘要 医疗保健质量方面的种族和民族不平等已在广泛的临床领域得到描述。 环境、患者群体和结果。临床医生的隐性偏见与因果路径有关 对于医疗保健方面的差异。现在我们必须针对原因并制定干预措施来缓解 并消除此类不平等现象。我们的首要目标是通过证据消除医疗保健不平等—— 为基础的干预措施。回应 RFA-NS-22-002：HEAL 倡议：促进疼痛领域的健康公平 管理层（R61/R33），该提案的目标是开发和测试两个方面的影响 克服临床医生隐性偏见和减轻疼痛管理不平等的干预措施 在急诊科寻求治疗阑尾炎或长骨骨折的儿童。 科学前提源于我们之前的工作：1）证明了种族和民族不平等 急诊室儿童的疼痛管理； 2）研究了隐性偏见在小插曲中的作用—— 基于健康结果； 3) 使用审核和反馈以及临床决策支持工具来改进 临床医生的绩效指标。我们将通过衡量以下方面的影响来巩固这项基础工作： 临床医生在提供者和护士之间对过程和结果测量存在隐性偏见，包括 评估和减轻疼痛。我们将使用利益相关者知情的方法来确定质量指标 以患者为中心。然后，我们将测试是否定期临床医生审核和反馈，通过提供 “公平报告卡”，以及提供嵌入实时电子健康记录的临床决策 支持可以作为有效的干预措施，减少临床结果中的种族/民族差异。这 研究意义重大，因为这两种干预措施都可以廉价传播并扩展到紧急情况 全国各部门以及其他临床场所，并适应各种临床条件。通过 创新的研究设计和严格的评估，该提案将提供关键证据并奠定 消除提供护理方面的种族和族裔不平等并改善儿童健康的基础 所有人的成果。