Using multimedia patient feedback to reduce disparities in VA healthcare

这项拟议的研究将为退伍军人面临的两个严重问题提供重要的见解 医疗保健：1)退伍军人事务部沟通改善干预措施的效果参差不齐 日期，以及2)退伍军人医疗保健中种族/民族差异的持续存在。我们已经确定了4“最佳” 患者认为在临床上最重要的医生沟通行为 互动。我们建议开发和评估医生沟通干预 特别关注这些行为。此外，我们大量的先导性研究数据来自于 不同的种族/民族使我们能够创建适用于沟通的干预 跨越耐心的种族/民族。在2个月内与医生和患者一起评估该干预措施 独立的退伍军人初级保健设置将有助于确定患者主导的 将不同种族/民族患者的意见纳入沟通重点可能会有所帮助 缩小白人和少数族裔退伍军人之间的健康结果差距。 我们的目标是(1)证明使用医生沟通的“最佳行为”作为 干预内容，以全面提高医生沟通技能并减少 与白人和种族/少数民族患者沟通的差异，以及(2)评估 患者“最佳行为”体验对患者感知和行为结果的影响。 我们收集了200多名初级保健患者的数据，他们观看了一段视频 他们自己和他们的医生在诊所就诊期间进行互动。从这些数据来看，我们 开发针对医生的教育干预措施，专门针对4个“最佳” 我们已经确定了4个最佳表演的剧本，并将进行标准化 贝勒医学院的患者将表演这些行为，并将进行视频记录。我们 然后将对16名初级保健医生(8名在 每个站点)和每个医生的36名患者。每隔3个月在第一个地点，医生将 参加由观看一段最佳表演的视频和参与 小组讨论，角色扮演重演该法案，并制定项目符号“外卖” 点数，以方便随后的召回。一旦完成，会话序列将在 第二个地点。在这两个地点，参与的医生和患者的临床互动将是 音频记录，并将分析音频记录出现的频率为4“最佳 在每次研究访问后，每个患者将完成验证的调查，以衡量患者的 医生在四个情感维度上的感知会影响患者随后的 感知和行为的结果。疗效将在患者人口统计数据中进行评估。

The proposed research will provide important insight into two serious problems for veterans' healthcare: 1) mixed effectiveness of communication improvement interventions in the VA to date, and 2) persistence of racial/ethnic disparities in VA healthcare. We have identified 4 "best acts" of physician communication that patients believe to be most important in a clinical interaction. We propose to develop and evaluate a physician communication intervention that focuses specifically on these acts. In addition, our abundance of pilot study data from patients of various races/ethnicities enables us to create an intervention applicable to communication that spans patient race/ethnicity. Evaluating this intervention with physicians and patients in 2 independent VA primary care settings will help determine whether a patient-driven communication focus that incorporates input from patients of varied race/ethnicity can help "close the gap" in health outcomes between white and minority veterans. We aim to (1) demonstrate the efficacy of using "best acts" of physician communication as content for an intervention to improve physician communication skills overall and reduce variation in communication with white versus racial/ethnic minority patients, and (2) assess the impact of patient experiences of "best acts" on patients' perceptual and behavioral outcomes. We have collected data from over 200 primary care patients as they viewed a video of themselves and their physician interacting during a clinic visit. From these data, we are developing an educational intervention for physicians that focuses specifically on the 4 "best acts" we have identified. Scripts of the 4 "best acts" will be developed, and standardized patients at Baylor College of Medicine will perform the acts, which will be video recorded. We will then conduct a 2-site longitudinal observational study of 16 primary care physicians (8 at each site) and 36 patients of each physician. At the first site at 3-month intervals, physicians will attend an instruction session consisting of viewing a video of one best act and participating in group discussion, role-playing re-enactment of the act, and formulation of bulleted "take-away" points to facilitate subsequent recall. Once completed, the sequence of sessions will occur at the second site. At both sites, clinical interactions of participating physicians and patients will be audio recorded, and audio recordings will be analyzed for frequency of occurrence of the 4 "best acts." After each study visit, each patient will complete validated surveys measuring patients' perceptions of their physician on 4 affective dimensions known to impact patients' subsequent perceptual and behavioral outcomes. Efficacy will be assessed across patient demographics.