Motivating providers to reduce racial disparities in their own practice

激励提供者在自己的实践中减少种族差异

• 批准号: 8395974
• 负责人: Diana J Burgess
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-01 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8395974
• 关键词: Address; Area; Awareness; Belief; Belief System; Caring; Cataloging; Catalogs; Clinical; Communication; Consensus; Educational workshop; Effectiveness; Employee; Goals; Guidelines; Health Personnel; Healthcare; Healthcare Systems; Individual; Inequality; Intervention; Interview; Intranet; Knowledge; Language; Lead; Learning; Mails; Measures; Methods; Minority; Motivation; Online Systems; Patient Noncompliance; Patients; Persuasive Communication; Policies; Provider; Qualitative Methods; Quality of Care; Readiness; Reading; Reporting; Research; Resistance; Services; Site; Social Marketing; Structure; Surveys; Testing; Training; Training Activity; Training Programs; Veterans; Work; base; behavior change; design; follow-up; health care quality; improved; innovation; insight; phase 1 study; programs; racial difference; research study; response; screening; skills; systematic review

DESCRIPTION (provided by applicant): Anticipated Impacts on Veterans Healthcare. Our long-term goal is to eliminate the provider contribution to racial disparities in access to and quality of care. The work proposed in this stud is an essential step in pursuit of that goal, as it is expected to result in knowledge about how to increase provider readiness to engage in actions to reduce healthcare disparities. Project deliverables are aimed at motivating providers to participate in programs designed to raise awareness and build skills to reduce healthcare disparities. Project deliverables include: 1) tailored narratives customized according to different healthcare inequality beliefs (for use in educational approaches, such as web-based training, where individually tailored training through branching is technically possible); 2) untailored narratives designed to enhance motivation for all providers, regardless of underlying beliefs (for use in situations where tailorig is not possible, such as Grand Round presentations) and 3) a communication toolkit, cataloging communication and intervention strategies to reduce disparities. Background. Racial disparities have been documented extensively both within and outside the Veteran Affairs healthcare system across a wide range of clinical areas and service types. Although a number of factors have been shown to contribute to disparities, including site of care, recent reports have concluded that healthcare providers likely contribute to a portion of these disparities. There is broad consensus that increasing the ability of clinicians and other healthcare employees to address disparities is a critical part of eliminating disparities, and there has been a surge of training activities and programs in response. What is missing, however, are empirically-based communication strategies for getting providers motivated to reduce disparities, particularly the sizable number that do not believe that providers contribute to racial differences in healthcare quality and who, due to a larger system of beliefs, might be resistant to messages about their own potential to contribute to disparities. This gap is a significant impediment to the successful implementation of disparities-reduction training programs aimed at providers, as motivation has been shown to be a critical piece of behavior change. Objectives. Aim 1 is to conduct semi-structured interviews with two groups of providers, stratified by whether they attribute healthcare inequalities more to factors internal or external to patients, to explore provider responses to narratives that vary in the extent to which external causes of healthcare disparities are emphasized. Aims 2a and 2b are to use a factorial experiment to test the hypothesis that narratives that are congruent with providers' beliefs about the cause of racial differences in healthcare quality will be most effective at increasing (2a) providers' readiness to take action to reduce disparities and (2b) providers' participation in one of two online "disparities reduction" training programs. Aim 2c is to identify the narrative type that leads to the highest level of participation in disparities-reduction training across all providers. Methods. Aim 1 will be addressed through a qualitative study (Phase 1) consisting of individual interviews with providers from 3 VA facilities (N = 60). Providers will be preselected based on their beliefs ascertained through a brief mixed-mode survey (intranet survey with mail follow-up) containing a screening question assessing providers' attributions of healthcare inequality and the interviews will be stratified into those two groups based on their responses to that screening question. Interviews will be transcribed and analyzed. This survey will also contain items that will be used to validate the screening question. For Aim 2 we will conduct a factorial experiment (intranet survey with mail follow-up), where VA providers will complete the screening question, read one of 2 types of narratives, learn about actions providers can take to reduce disparities, complete a measure assessing readiness to take action to reduce disparities, and receive an invitation to participate in disparities- reduction training programs. Participation will be assessed with a follow-up survey a month after completion of the initial survey.

描述（由申请人提供）： 对退伍军人医疗保健的预期影响。我们的长期目标是消除提供者在获得护理和护理质量方面对种族差异的贡献。这项研究中提出的工作是追求这一目标的重要一步，因为它预计将导致有关如何 提高提供者参与减少医疗保健差异的行动的准备程度。项目交付成果旨在激励提供者参与旨在提高认识和培养技能以减少医疗保健差距的计划。项目交付成果包括：1）根据不同的医疗保健不平等信念定制的定制叙述（用于教育方法，如网上培训，在这种情况下，通过分支进行个性化培训在技术上是可能的）; 2）不适合的叙述，旨在提高所有提供者的动机，无论潜在的信念如何（用于无法进行量身定制的情况，如大型圆桌会议）和3）一个交流工具包，对交流和干预战略进行编目，以减少差距。背景种族差异已被广泛记录在退伍军人事务部医疗保健系统内外的广泛的临床领域和服务类型。虽然许多因素已被证明有助于差异，包括护理地点，但最近的报告得出结论，医疗保健提供者可能导致这些差异的一部分。人们普遍认为，提高临床医生和其他医疗保健员工解决差异的能力是消除差异的关键部分，因此出现了大量的培训活动和计划。然而，缺少的是基于实践的沟通策略，让供应商有动力减少差异，特别是相当大的数量，不相信供应商有助于医疗保健质量的种族差异，以及谁，由于更大的信仰体系，可能会抵制有关他们自己的潜力，以促进差异的信息。这一差距是成功实施针对供应商的降低风险培训计划的重大障碍，因为动机已被证明是行为改变的关键因素。目标.目的1是进行半结构化访谈，两组供应商，分层，他们是否属性医疗保健 不平等更多的因素内部或外部的病人，探索供应商的反应，在不同程度上强调医疗保健差异的外部原因的叙述。目的2a和2b是使用析因实验来检验假设，即与提供者关于医疗保健质量种族差异原因的信念一致的叙述将最有效地提高（2a）提供者采取行动的准备程度， 减少差异和（2b）提供者参与两个在线“减少差异”培训方案之一。目标2c是确定导致所有提供者最高程度地参与减少伤害培训的叙述类型。方法.目标1将通过定性研究（第1阶段）解决，包括与3个VA机构（N = 60）的提供者进行的单独访谈。提供者将根据他们的信念进行预选，通过一个简短的混合模式调查（内联网调查与邮件跟进），其中包含一个筛选问题，评估提供者的医疗保健不平等的归因，访谈将分为这两个群体的基础上，他们对筛选问题的回答。访谈将被转录和分析。该调查还将包含用于验证筛选问题的项目。对于目标2，我们将进行析因实验（带邮件随访的内联网调查），VA提供者将完成筛选问题，阅读2种类型的叙述之一，了解提供者可以采取的减少差异的行动，完成评估采取行动减少差异的准备程度的措施，并收到参加减少差异培训计划的邀请。将在初步调查完成后一个月进行后续调查，对参与情况进行评估。