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