Understanding Mechanisms that lead to Disparities in Trauma Outcomes

了解导致创伤结果差异的机制

• 批准号: 7871539
• 负责人: Adil H Haider
• 金额: $ 12.89万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-03 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7871539
• 关键词: Address; African American; Attitude; Awareness; Caring; Clinical; Clinical Treatment; Color; Comorbidity; Conscious; Data; Data Analyses; Data Collection; Development; Diagnostic tests; Education; Emergency Medicine; Funding; General Population; Health; Health Personnel; Health system; Healthcare; Heart Diseases; Hispanics; Household; Human; Implicit Association Test; Income; Individual; Inferior; Institute of Medicine (U.S.); Insurance Coverage; Internet; Lead; Malignant Neoplasms; Measures; Medical; Minority; Nature; Not Hispanic or Latino; Occupations; Operative Surgical Procedures; Outcome; Patients; Prejudice; Prevalence; Principal Investigator; Procedures; Process; Provider; Public Health; Quality of Care; Race; Reporting; Research; Role; Secure; Services; Social Psychology; Socioeconomic Status; Solutions; Stereotyping; Surgeon; Surveys; Testing; Trauma; Uncertainty; Unconscious State; United States National Institutes of Health; base; blind; clinical decision-making; cohort; cost; design; effective intervention; functional outcomes; health care delivery; improved; injured; innovation; interest; medical specialties; member; mortality; novel; preference; programs; prospective; public health relevance; racial and ethnic disparities; racial discrimination; socioeconomics; tool

DESCRIPTION (provided by applicant): Racial disparities in health care are well described. Provision of differential or inferior care to minorities is widely believed to be a major reason for the health gaps seen between White patients and minorities such as African Americans / Blacks and Hispanics. The underlying factors and mechanisms that lead to poorer quality of care for minorities have not been fully elucidated and the NIH seeks to "enhance understanding of the influence of racial discrimination in health care delivery and its association with disparities." This study seeks to test two hypotheses 1) Blacks and Hispanics receive inferior trauma care which leads to increased complications and worse long term clinical and functional outcomes and 2) Similar to the general population, trauma care providers possess an unconscious (implicit) racial bias towards Black patients which impacts clinical decision making. To test hypothesis #1, a comprehensive analysis of data collected during the NIH/CDC funded prospective, multicenter National Study on Costs and Outcomes of Trauma (NSCOT) will be conducted to determine A) The presence of racial disparities in mortality and long term functional outcomes, controlling for patient co-morbidities, insurance status and measures of socioeconomic status including median household income, education and occupation. B) Determine if minority patients (Blacks and Hispanics) in NSCOT received differential clinical treatments, diagnostic tests, major procedures or suffered more complications than White patients; and C) Determine how differences in clinical treatments, diagnostic tests, major procedures or complications lead to worse outcomes. Testing hypothesis #2 entails original data collection to assess the prevalence of unconscious racial bias among trauma surgeons and determine its potential association with clinical decision-making. For this purpose the Implicit Association Test (IAT), a valid and reliable measure of implicit bias will be administered to more than three hundred trauma surgeon members of the Eastern Association for the Surgery of Trauma (EAST) via an internet based secure survey. Through this web survey we will A) Measure the presence of unconscious racial attitudes among trauma care providers, B) Use clinical vignettes to determine if patient race impacts a trauma surgeon's clinical decision-making (i.e. do trauma surgeons treat Black or White patients differently?); and C) Correlate provider IAT scores to clinical vignette decisions in an effort to determine if implicit bias impacts clinical decision making. Conducted by an interdisciplinary team that crosses the boundaries of social psychology, emergency medicine, public health and trauma surgery this study has the potential to help us understand the underlying causes of racial disparities after trauma care. Results of this study will be used to inform the development of innovative solutions directed at effectively diminishing or eliminating health care disparities. PUBLIC HEALTH RELEVANCE: This study is designed to help elucidate the factors and mechanisms that lead to racial disparities after trauma. The first part of the study will analyze care provided to thousands of severely injured trauma patients to determine if Black or Hispanic patients received differential treatments or care processes when compared to similarly injured White patients. The second part of the study will use an internet based test to determine if unconscious racial bias effects clinical decision making by trauma surgeons. This study will give us valuable information that can be used to develop innovative solutions to help diminish and potentially eliminate health care disparities.

描述（由申请人提供）：医疗保健中的种族差异得到了很好的描述。人们普遍认为，向少数群体提供差别或较差的护理是白色患者与非裔美国人/黑人和西班牙裔等少数群体之间存在健康差距的主要原因。导致少数群体保健质量较差的根本因素和机制尚未得到充分阐明，国家卫生研究院力求“提高对种族歧视在保健提供方面的影响及其与不平等之间联系的认识。“这项研究旨在测试两个假设1）黑人和西班牙裔人接受劣质创伤护理，导致并发症增加，长期临床和功能结果更差，2）与一般人群相似，创伤护理提供者对黑人患者有无意识的（隐含的）种族偏见，影响临床决策。为了检验假设1，将对NIH/CDC资助的创伤成本和结局前瞻性、多中心全国研究（NSCOT）期间收集的数据进行综合分析，以确定A）死亡率和长期功能结局中存在种族差异，控制患者共病、保险状况和社会经济状况指标，包括家庭收入中位数、教育和职业。B）确定NSCOT中的少数民族患者（黑人和西班牙裔）是否接受了不同的临床治疗、诊断测试、重大手术或比白色患者遭受更多的并发症;和C）确定临床治疗、诊断测试、重大手术或并发症的差异如何导致更差的结果。检验假设2需要原始数据收集，以评估创伤外科医生无意识种族偏见的患病率，并确定其与临床决策的潜在关联。为此，将通过基于互联网的安全调查，对东部创伤外科协会（EAST）的300多名创伤外科医生成员进行内隐关联测试（IAT），这是一种有效且可靠的内隐偏倚测量方法。通过这项网络调查，我们将A）测量创伤护理提供者中无意识种族态度的存在，B）使用临床小插曲来确定患者种族是否影响创伤外科医生的临床决策（即创伤外科医生治疗黑人或白色患者的不同？）;以及C）将提供者IAT分数与临床小插曲决策相关联，以努力确定隐式偏差是否影响临床决策制定。这项研究由一个跨学科的团队进行，跨越了社会心理学、急诊医学、公共卫生和创伤外科的界限，有可能帮助我们了解创伤护理后种族差异的根本原因。这项研究的结果将被用来告知针对有效减少或消除医疗保健差距的创新解决方案的发展。 公共卫生相关性：这项研究旨在帮助阐明导致创伤后种族差异的因素和机制。该研究的第一部分将分析为数千名严重受伤的创伤患者提供的护理，以确定与同样受伤的白色患者相比，黑人或西班牙裔患者是否接受了不同的治疗或护理过程。研究的第二部分将使用基于互联网的测试来确定无意识的种族偏见是否会影响创伤外科医生的临床决策。这项研究将为我们提供有价值的信息，可用于开发创新的解决方案，以帮助减少和潜在地消除医疗保健差距。