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

描述（由申请人提供）：即使在控制保险状况、教育和其他社会经济因素的情况下，与白人和男性患者相比，美国种族/少数民族和女性患者的医疗保健结果往往更差。越来越多的研究试图了解人际和制度偏见对这些观察到的不平等的贡献。然而，由于缺乏捕捉这一现象的标准化方法，进一步描述和减少患者保健歧视经历的努力受到限制。现在，我们在早期工作的基础上，寻求最终确定和测试一个题库，即患者报告的护理歧视经历工具（PreDict），该工具可用于评估以患者为中心的护理体验，比较和报告医院层面的表现，并最终提高医疗保健机构内的护理质量。在当前的应用程序中，我们特别建议：)在对康涅狄格州、弗吉尼亚州和科罗拉多州20家医院最近出院的患者样本（n=6000）进行现场测试后，将先进的统计技术应用于一组候选项目，以确定最终的项目库；2)将PreDict发展为医院级别的评估措施，并将其应用为质量改进工具；3)描述医院在PreDict项目上的表现与其他医院质量指标之间的关系。拟议的工作是合乎逻辑的下一步，朝着一个标准化的方法，对医疗歧视的病人经验的数据收集。为了扩大这一领域的证据基础，并为有效的干预措施提供信息，仍然有必要制定系统的战略，研究医疗机构中患者的歧视报告。

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.