Validating the Patient-reported Experiences of Discrimination in Care Tool (PreDi

描述（由申请人提供）：与白色和男性患者相比，即使在控制保险状况、教育和其他社会经济因素的情况下，美国种族/少数民族和女性患者的医疗结局通常更差。越来越多的研究试图了解这些观察到的不平等的人际和机构偏见的贡献。然而，由于缺乏标准化的方法来捕捉这种现象，进一步描述和减少患者医疗歧视经历的努力受到限制。我们现在建立在我们早期的工作，并寻求最终确定和测试一个项目库，患者报告的歧视护理工具（PreDict）的经验，可用于评估以患者为中心的护理经验，比较和报告医院一级的性能，并最终提高医疗机构内的医疗服务质量。在本申请中，我们特别提出：）在用最近从康涅狄格州、弗吉尼亚州和科罗拉多州的二十家医院出院的患者的样本（n=6000）对候选项进行现场测试之后，将高级统计技术应用于候选项集合，以便确定最终的项库; 2）开发PreDict作为医院级评估措施，并将其应用为质量改进工具; 3）描述PreDict项目的医院级绩效与医院质量的其他措施之间的关系。拟议的工作是朝着标准化方法收集患者医疗歧视经历数据的合理下一步。仍然有必要制定一项系统的战略，对医疗机构歧视患者的报告进行研究，以扩大这一领域的证据基础，并为有效的干预措施提供信息。

DESCRIPTION (provided by applicant): Racial/ethnic minority and female patients in the United States often have worse healthcare outcomes when compared with white and male patients even when controlling for insurance status, education, and other socioeconomic factors. A growing body of research seeks to understand the contribution interpersonal and institutional bias to these observed inequities. However, efforts to further describe and reduce patient experiences of healthcare discrimination are limited by the lack of a standardized approach to capture this phenomenon. We now build upon our earlier work and seek to finalize and test an item bank, the Patient-Reported Experiences of Discrimination in Care Tool (PreDict), that can be used to assess the patient-centeredness of the care experience, to compare and report on hospital-level performance, and to ultimately improve the quality of care delivery within healthcare organizations. In this current application, we specifically propose to: ) apply advanced statistical techniques to a set of candidate items after field testing them with a sample (n=6000) of patients recently discharged from twenty hospitals across the states of Connecticut, Virginia, and Colorado in order to determine the finalized item bank; 2) develop PreDict as a hospital-level assessment measure with application as a quality improvement tool; and 3) describe the relationship between hospital-level performance on PreDict items and other measures of hospital quality. The proposed work is the logical next step towards a standardized approach to data collection on patient experiences of healthcare discrimination. A systematic strategy towards the study of patient reports of discrimination across healthcare organizations remains necessary to expand the evidence base in this area and to inform effective interventions.