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Opening the Black Box of Cultural Competence

打开文化能力的黑匣子

基本信息

批准号：
8982128
负责人：
SOMNATH SAHA
金额：
--
依托单位：
PORTLAND VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-01 至 2021-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8982128
关键词：
AIDS/HIV problem AIDS/HIV problem Address Address Adopted Adopted African American African American American American Attention Attention Attitude Attitude Audiotape Audiotape Behavior Behavior Boxing Caring Caring Clinic Clinic Clinical Clinical Code Code Communication Communication Coupled Coupled Data Data Analyses Diabetes Mellitus Diabetes Mellitus Dimensions Dimensions Goals Goals Health Occupations Health Occupations Health Personnel Health Personnel Health Professional Health Professional Health Services Healthcare Healthcare Intervention Intervention Interview Interview Maps Maps Measures Measures Medical Medical Medical Care Team Medical Care Team Medical center Medical center Methods Methods Minority Minority Minority Groups Outcome Outcome Patient Care Patient Care Patient Self-Report Patient Self-Report Patient-Centered Care Patient-Centered Care Patients Patients Perception Perception Phase Phase Primary Health Care Primary Health Care Process Process Professional Organizations Professional Organizations Provider Provider Quality of Care Quality of Care Race Race Reaction Reaction Recruitment Activity Reporting Reporting Research Research Resources Resources Sampling Sampling Schools Schools Self Management Self Management Series Series Shapes Shapes Side Side Societies Source Source Surveys Surveys Testing Testing Time Time Training Training Training Programs Training Programs Transcript Transcript Variant Variant Veterans Veterans Visit Visit Work Work base base care outcomes care providers communication behavior communication behavior cultural competence cultural competence diabetic patient diabetic patient disparity reduction effective intervention effective intervention ethnic difference ethnic minority population glycemic control glycemic control health care delivery health care delivery health care disparity health care quality health care quality health care service health care service organization health care service organization health training health training improved improved instrument instrument member member patient population patient population patient response patient subsets patient-clinician communication programs programs racial and ethnic racial disparity racial disparity racial health disparity racial minority racial/ethnic difference recruit response skills skills systematic review systematic review uptake uptake

项目摘要

DESCRIPTION (provided by applicant): Racial and ethnic minority Americans receive lower quality health care than non-minorities in the U.S. These disparities are evident across a wide range of health care services, including the care of diabetes mellitus. Cultural competence (CC) training has become the principal vehicle adopted by the health professions to address healthcare disparities. CC has been widely endorsed and deployed in the U.S., but there is little consistency to what is offered in CC programs and little evidence that CC training as currently delivered is improving health care quality or equity as intended. Given the substantial resources and time being devoted to CC training, it is critical that CC programs are informed by evidence about what will improve the ability of providers and healthcare teams to deliver high-quality care equitably, across diverse patient populations. This project builds on prior work that: 1) defined CC among health professionals by producing a conceptual map of CC dimensions from a systematic review of conceptual frameworks; 2) used that conceptual map to develop an instrument measuring CC among primary care providers (PCPs); and 3) demonstrated that CC, as measured by the instrument, was associated with higher quality care for African American patients, and reduced racial disparity. This project will extend the study of CC beyond PCPs to include other Patient Aligned Care Team (PACT) members, and attempt to discern why higher CC is associated with more equitable care, specifically, what high CC providers are doing differently in their clinical encounters that results in higher quality care for African American patients. The aims of the study are to: 1. Understand differences in patient-provider communication among high and low CC primary care providers. 2. Understand patients' perceptions of their interactions and relationships with high and low CC providers/PACTs. 3. Understand the contribution of CC among providers/PACTs to quality and equity of diabetes care. These aims will be addressed using a mixed-methods approach that will include quantitative and qualitative analysis of communication behaviors observed in audiotaped clinical encounters, coupled with quantitative surveys and qualitative interviews of patients about their perceptions of the encounters and their relationships with their PCPs and PACT members. The study will be conducted in 4 VA Medical Centers. A target sample of 50 PCPs will be recruited, 25 high and 25 low on self-assessed CC. PACT teamlet members working with these PCPs will be recruited. Patients with diabetes from each PCP's primary care panel will be recruited, with a target of 5 African American and 5 white patients per PCP. Patients' visits to their PCPs will be audio- recorded and the dialogue then coded for communication content using validated communication coding systems that evaluate different types of communication behaviors. Differences in communication by provider CC will be analyzed. We will also evaluate associations between PCP/PACT CC and other outcomes, including the quality of interpersonal care, patients' perceptions of PCP/PACT CC, diabetes understanding and self-management, and glycemic control. A subsample of patients from PCPs in the top and bottom CC quintiles will be interviewed, with a goal of 1 African American and 1 white patient for each of these PCPs. Patients will listen to their audiotaped clinical encounters and offer perspectives on the interaction and their relationships with the PCP. For these patients, transcripts from both the interview and from the audio-recorded clinical encounter will be qualitatively analyzed, side-by-side. The mixed-methods approach is intended to provide both breadth and depth in understanding how provider CC manifests in clinical interactions with patients and contributes to disparities in healthcare quality and outcomes. Understanding how provider CC manifests will inform interventions that are more likely to be effective in reducing disparities, because they will be based on empirical evidence of how providers who deliver more equitable care interact with patients.

描述（由申请人提供）：在美国，种族和少数民族的美国人获得的医疗保健质量低于非少数民族，这些差异在广泛的医疗保健服务中很明显，包括糖尿病的护理。文化能力（CC）培训已成为卫生专业人员解决医疗保健差距的主要手段。CC已在美国得到广泛认可和部署，但是，CC计划提供的内容几乎没有一致性，也没有证据表明目前提供的CC培训正在改善医疗保健质量或公平性。鉴于CC培训投入了大量的资源和时间，因此CC计划必须获得有关如何提高提供者和医疗团队在不同患者人群中公平提供高质量护理的能力的证据。本项目建立在先前的工作基础上：1）通过对概念框架的系统性审查，制作CC维度的概念图，在卫生专业人员中定义CC; 2）使用该概念图开发一种测量初级保健提供者（PCP）中CC的工具;和3）证明了CC，如仪器所测量的，与非洲裔美国人患者的更高质量护理相关，减少种族差异。该项目将扩大研究的CC超出PCP，包括其他患者对齐的护理团队（PACT）的成员，并试图辨别为什么较高的CC与更公平的护理，特别是，什么高CC供应商正在做不同的临床遭遇，导致更高质量的护理非洲裔美国人的患者。本研究的目的是：1.了解高CC和低CC初级保健提供者之间患者-提供者沟通的差异。2.了解患者对他们与高和低CC提供者/PACTs的互动和关系的看法。3.了解提供者/PACTs之间的CC对糖尿病护理质量和公平性的贡献。这些目标将使用混合方法的方法，将包括定量和定性分析的沟通行为中观察到的录音临床遭遇，再加上定量调查和定性访谈的病人对他们的看法的遭遇和他们的关系与他们的PCP和PACT成员。本研究将在4个VA医学中心进行。将招募50名PCP的目标样本，25名高，25名低自我评估CC。将征聘与这些项目协调员一起工作的项目协调行动小组成员。将从每个PCP的初级保健小组招募糖尿病患者，每个PCP的目标是5名非洲裔美国人和5名白色患者。患者对其PCP的访视将被录音，然后使用经验证的通信编码系统（评估不同类型的通信行为）将对话编码为通信内容。将分析提供商CC的通信差异。我们还将评估PCP/PACT CC与其他结局之间的相关性，包括人际护理质量、患者对PCP/PACT CC的看法、糖尿病理解和自我管理以及血糖控制。将对来自CC五分位数最高和最低的PCP患者的子样本进行访谈，目标是每种PCP均包括1名非洲裔美国人和1名白色患者。患者将听取他们的录音临床遭遇，并提供互动的观点和他们与PCP的关系。对于这些患者，将对访谈和录音记录的临床遭遇的成绩单进行定性分析。混合方法旨在提供广度和深度，以了解提供者CC如何在与患者的临床互动中表现出来，并导致医疗质量和结果的差异。了解提供者CC清单将为更有可能有效减少差异的干预措施提供信息，因为它们将基于提供更公平护理的提供者如何与患者互动的经验证据。