Effect of implicit racial bias on recommendation of patients for total knee repla

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DESCRIPTION (provided by applicant): Racial and ethnic health disparities abound, with decreased quality of health care in these underserved communities. The reasons for these health inequities are complex and multi-layered. As noted by the Institute of Medicine, there are historic and contemporary social inequities that have been embodied in these populations and in the health systems that care for them. In addition, racial biases of health care providers also may play a role in the unequal treatment of minority populations. Racial stereotyping and bias have been identified as factors in the delivery of cardiovascular disease care, pain management, and mental health care. Given the well-documented disparity in the receipt of total knee replacements between African-American and white patients with severe osteoarthritis, research is sorely needed to better understand what role racial stereotyping and bias plays in creating these inequities in the provision of this treatment. In the proposed research project, we will objectively measure physicians' racial stereotyping and bias and evaluate its association with those physicians' recommendations of patients for TKR. We also propose an innovative educational intervention aimed at reducing the effect of racial bias on clinical decision-making and will assess its efficacy. Findings from this exploratory study will be used to develop a larger, more long-term study of racial stereotyping and bias in clinical decision-making and methods for intervening to mitigate their effects. Specific Aim 1 will test whether physicians express explicit racial bias, using a Web-based survey instrument. Specific Aim 2 will test whether physicians show implicit racial bias, using Web-based Implicit Association Tests (IATs). Specific Aim 3 will evaluate whether the magnitude of implicit bias predicts physician recommendation of TKR for African-American and white patients with severe osteoarthritis. Specific Aim 4 will assess whether use of the Web-based IAT as an educational intervention decreases the effect of implicit racial bias on physician recommendation of TKR. Public Health Relevance: The proposed research project tests an intervention to help physicians manage and, perhaps, eliminate their racial bias. If this intervention proves effective, we will have a powerful tool to help reduce racial health disparities.