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: 8514637
• 负责人: Adil H Haider
• 金额: $ 12.9万
• 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/8514637
• 关键词: Address; African American; Attitude; Awareness; Caring; Centers for Disease Control and Prevention (U.S.); 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; trauma care

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(申请人提供)：卫生保健方面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人患者与非裔美国人/黑人和西班牙裔等少数群体之间出现健康差距的一个主要原因。导致少数群体护理质量较差的潜在因素和机制尚未完全阐明，美国国立卫生研究院试图“加强对提供保健服务中种族歧视的影响及其与差异的联系的了解”。这项研究试图检验两个假设：1)黑人和西班牙裔接受的创伤护理质量较低，导致并发症增加，长期临床和功能结果更差；2)与一般人群类似，创伤护理提供者对黑人患者存在无意识(隐性)种族偏见，这影响了临床决策。为了验证假设1，将对NIH/CDC资助的关于创伤的成本和结果的前瞻性多中心全国研究(NSCOT)期间收集的数据进行全面分析，以确定A)死亡率和长期功能结果方面是否存在种族差异，控制患者的合并症、保险状况和包括家庭收入中位数、教育和职业在内的社会经济状况的衡量标准。B)确定NSCOT中的少数族裔患者(黑人和西班牙裔)是否接受了不同的临床治疗、诊断测试、主要程序或遭受了比白人患者更多的并发症；以及c)确定临床治疗、诊断测试、主要程序或并发症的差异如何导致更糟糕的结果。检验假设2需要收集原始数据，以评估创伤外科医生中无意识种族偏见的流行率，并确定其与临床决策的潜在关联。为此，将通过一项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联想测试(IAT)，这是一种有效和可靠的内隐偏见衡量标准。通过这项网络调查，我们将A)衡量创伤护理提供者中是否存在无意识的种族态度，B)使用临床片段来确定患者种族是否影响创伤外科医生的临床决策(即，创伤外科医生对待黑人或白人患者是否有所不同？)C)将提供者IAT评分与临床场景决策相关联，以努力确定隐性偏见是否会影响临床决策。这项研究由一个跨越社会心理学、急救医学、公共卫生和创伤外科的跨学科团队进行，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指导制定旨在有效缩小或消除卫生保健差距的创新解决方案。 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。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，以确定与类似受伤的白人患者相比，黑人或西班牙裔患者是否接受了不同的治疗或护理过程。这项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，以帮助缩小甚至潜在地消除医疗保健差距。

项目成果

Worse outcomes among uninsured general surgery patients: Does the need for an emergency operation explain these disparities?

• DOI: 10.1016/j.surg.2014.04.039
• 发表时间: 2014-08-01
• 期刊: SURGERY
• 影响因子: 3.8
• 作者: Schwartz, Diane A.;Hui, Xuan;Haider, Adil H.
• 通讯作者: Haider, Adil H.

Reply to Letter: "ATLS Protocols of Initial Intravenous Fluid Administration for Trauma Patients; Needing a Revision?".

回复信件：“创伤患者初始静脉输液的 ATLS 方案；需要修订吗？”。

• DOI: 10.1097/sla.0000000000000484
• 发表时间: 2015
• 期刊: Annals of surgery
• 影响因子: 9
• 作者: Haut,ElliottR;Haider,AdilH;Cotton,BryanA;Stevens,KentA;Cornwell3rd,EdwardE;Efron,DavidT
• 通讯作者: Efron,DavidT

Should the IDC-9 Trauma Mortality Prediction Model become the new paradigm for benchmarking trauma outcomes?

• DOI: 10.1097/ta.0b013e318256a010
• 发表时间: 2012-06-01
• 期刊: JOURNAL OF TRAUMA AND ACUTE CARE SURGERY
• 影响因子: 3.4
• 作者: Haider, Adil H.;Villegas, Cassandra V.;Schneider, Eric B.
• 通讯作者: Schneider, Eric B.

Factors affecting the likelihood of presentation to the emergency department of trauma patients after discharge.

• DOI: 10.1016/j.annemergmed.2011.04.021
• 发表时间: 2011-11
• 期刊: ANNALS OF EMERGENCY MEDICINE
• 影响因子: 6.2
• 作者: Ladha, Karim S.;Young, J. Hunter;Ng, Derek K.;Efron, David T.;Haider, Adil H.
• 通讯作者: Haider, Adil H.

Lower extremity vascular injuries: Increased mortality for minorities and the uninsured?

• DOI: 10.1016/j.surg.2011.07.052
• 发表时间: 2011-10-01
• 期刊: SURGERY
• 影响因子: 3.8
• 作者: Crandall, Marie;Sharp, Douglas;Esposito, Thomas
• 通讯作者: Esposito, Thomas