Does a Psychiatric Comorbidity Affect the Management of Diabetes

精神合并症是否影响糖尿病的治疗

• 批准号: 8220979
• 负责人: John B McKinlay
• 金额: $ 48.1万
• 依托单位: NEW ENGLAND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-05 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8220979
• 关键词: Address; Adherence; Affect; Age; Area; Attention; Behavior; Behavioral; Belief; Black race; Caring; Characteristics; Clinical; Clinical Management; Cognitive; Comorbidity; Cues; Data; Decision Making; Development; Diabetes Mellitus; Diagnosis; Diagnostic; Documentation; Eczema; Epidemic; Ethnic Origin; Experimental Designs; Female; Gender; Geographic Locations; Glycosylated hemoglobin A; Health; Health Policy; Health Services Research; Healthcare Systems; Heart Diseases; Hypertension; Intervention; Label; Link; Measures; Medical; Medical Education; Mental Depression; Mental Processes; Mental disorders; Motivation; NIH Program Announcements; National Institute of Mental Health; Ownership; Patients; Perception; Pharmaceutical Preparations; Physicians; Policies; Practice Guidelines; Process; Production; Provider; Public Facilities; Published Practice Guidelines; Race; Regimen; Relative (related person); Reporting; Research; Risk; Schizophrenia; Signs and Symptoms; Socioeconomic Status; Stigmata; Testing; Translational Research; Variant; Videotape; Weight Gain; Woman; Work; bench to bedside; clinical decision-making; design; diabetes management; experience; health disparity; health literacy; male; malignant breast neoplasm; medical specialties; meetings; novel; older patient; research study; sex; social; social stigma

DESCRIPTION (provided by applicant): Results from our own research over 15 years shows that what a patient gets (in terms of diagnosis, medications, tests ordered and management decisions) is as much a function of who the patient is (age, gender, race/ethnicity), who the provider is (gender and level of experience) and where the care is delivered (private vs. public facility, practice culture, geographic location, or health care system), as it is of what signs and symptoms are actually presented. Further progress in the field requires moving beyond endless documentation of differences and toward understanding the quality of decision making-why these differences persist. Our proposed study addresses priorities identified across NIH program announcements on mental illness stigma, health disparities, and mechanisms linking physical and mental disorders (PA-07-027, PA-07- 212, IOM reports Crossing the Quality Chasm and Unequal Treatment, and a recent NIMH meeting, "Translational Research: Bridging Basic and Applied Perspectives" [May 2006]). The research proposed here would extend previous work by examining how clinical decision making (CDM) processes operate in the case of a physical illness (diabetes) that is co-occurring with potentially stigmatizing mental illness conditions. Estimating the influence of nonmedical influences on CDM under these circumstances will help us understand stigma production and the specific cues from patients that trigger differential treatment decisions (e.g., diagnostic labels versus observable behavioral differences relative to a non-stigmatizing control comorbidity). An experimental design will further allow us to measure variation in clinical behavior according to patient and provider characteristics, while our use of think-aloud qualitative data will allow for in-depth analyses of how physicians make decisions. In order of priority, specific aims include: AIM 1: To measure how the presence of one of 4 comorbid conditions depicting varying levels of stigma (schizophrenia with bizarre affect; schizophrenia with normal affect; depression, and eczema) influence clinical management of the videotaped vignette scenario. AIM 2: To use think-aloud data and qualitative analyses to understand the underlying cognitive reasoning and mental processes that produce the clinical decisions we observe. AIM 3: To estimate the influence of "patient" attributes (race/ethnicity, gender, and age) on clinical management of the videotaped vignette scenario. AIM 4: To estimate the influence of physician characteristics (age/clinical experience and gender) on clinical management of the videotaped vignette scenario. AIM 5: To measure the influence of organizational features of the health care system (e.g., size and ownership of practice, practice culture) as covariates with respect to the clinical scenario. Findings from this research will have practical implications for translational research (moving research from "bench to bedside"), health policy, and medical education and are discussed. PUBLIC HEALTH RELEVANCE: This proposed study uses a video vignette factorial experiment and qualitative think-aloud data to study the influence of (1) potentially stigmatizing comorbidities (schizophrenia with normal affect, schizophrenia with bizarre affect, depression, and eczema); (2) patient; (3) physician; and (4) healthcare system attributes on diagnostic and treatment decisions for a case of diagnosed diabetes.

描述（由申请人提供）：15年来我们自己研究的结果表明，患者获得的（在诊断，药物，测试订购和管理决策方面）同样重要的是患者是谁（年龄，性别，种族/种族/种族/种族），提供者是（性别和性别和经验水平），以及在何处提供了范围，私人的位置，私人的位置，范围的范围，地理位置，地理位置，地理位置，地理位置，地理位置，地理位置，地理位置，地理位置，地理位置，地理位置，地理位置，范围，范围，地理位置，地理位置，地理位置，地理位置，范围，范围。提出。该领域的进一步进展需要超越无限的差异文献，而要了解决策的质量 - 为什么这些差异持续存在。我们提出的研究解决了NIH计划中确定的有关精神疾病污名，健康差异和与身体疾病联系起来的机制（PA-07-07-027，PA-07-212，IOM报告跨越了质量的鸿沟和不平等的治疗，以及最近的NIMH会议，“转化研究：BRIDINACITY BASSICAD基本和Applied Perspect pers Persective”）[2006] [[2006）] [[2006] []此处提出的研究将通过研究临床决策（CDM）过程如何在身体疾病（糖尿病）中与潜在污名化精神疾病疾病进行污名化的情况进行扩展。在这种情况下，估计非医学影响对CDM的影响将有助于我们了解触发差异治疗决策的患者的污名和特定线索（例如，诊断标签与可观察到的行为差异相对于非识别性控制合并症）。实验设计将进一步允许我们根据患者和提供者的特征来衡量临床行为的变化，而我们使用思考的定性数据将允许对医师做出决定的深入分析。根据优先级的顺序，具体目的包括：目标1：衡量4种合并症之一的存在如何描述污名水平的水平（具有怪异影响的精神分裂症；具有正常影响的精神分裂症；抑郁症和湿疹）如何影响Videotapated Vignette vignette风景的临床管理。目标2：使用思考数据和定性分析来了解产生我们观察到的临床决策的基本认知推理和心理过程。目标3：估计“患者”属性（种族/种族，性别和年龄）对录像插图场景的临床管理的影响。目标4：估计医师特征（年龄/临床经验和性别）对录像插图场景的临床管理的影响。目的5：衡量医疗保健系统组织特征的影响（例如，实践的规模和所有权，实践文化），如临床情况。这项研究的结果将对转化研究（从“卧床”进行转化研究），卫生政策和医学教育有实际影响，并进行了讨论。公共卫生相关性：这项拟议的研究使用视频小插图实验和定性思维数据来研究（1）（1）可能污名化合并症的影响（具有正常影响的精神分裂症，精神分裂症，具有怪异的情感，抑郁，抑郁和湿疹）； （2）患者； （3）医师； （4）医疗保健系统属性属于诊断糖尿病病例的诊断和治疗决策。

项目成果

Physician styles of decision-making for a complex condition: Type 2 diabetes with co-morbid mental illness.

针对复杂病症的医生决策风格：2 型糖尿病并伴有精神疾病。

• DOI: 10.5750/ejpch.v2i4.831
• 发表时间: 2014
• 期刊: European journal for person centered healthcare
• 作者: Trachtenberg,FeliciaL;Pober,DavidM;Welch,LisaC;McKinlay,JohnB
• 通讯作者: McKinlay,JohnB