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Racial Differences in Treatment with Hysterectomy: a Multilevel Investigation

子宫切除术治疗的种族差异：多层次调查

基本信息

批准号：
9381334
负责人：
Whitney Ragan Robinson
金额：
$ 60.29万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-26 至 2022-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9381334
关键词：
Affect Anemia Automobile Driving Bilateral Caring Clinical Complex Computerized Medical Record Data Decision Making Disease Ensure Ethnic Origin Excision Goals Gynecologic Gynecologic Surgical Procedures Gynecology Health Health system Healthcare Healthcare Systems High Prevalence Hispanics Hospitals Hysterectomy Infertility Institution Investigation Literature Long-Term Effects Malignant neoplasm of ovary Mammalian Oviducts Measures Medical Medical Records Menopausal Symptom Minority Operative Surgical Procedures Ovarian Ovary Pain Patients Pattern Positioning Attribute Premenopause Prevalence Provider Ptosis Quality of life Race Research Sampling Secondary to Severities Stroke Surgical complication Symptoms System Testing Time Tubal Excisions Uterine Fibroids Uterus Variant Weight Woman Work aged alternative treatment cancer risk endometriosis ethnic difference experience health care disparity improved innovation middle age mortality patient oriented racial and ethnic racial and ethnic disparities racial difference reproductive treatment effect

项目摘要

1 PROJECT SUMMARY/ABSTRACT 2 3 Every year, millions of U.S. women must decide whether to have their uteri removed to treat painful and 4 incapacitating gynecologic disorders, such as uterine fibroids, endometriosis, and prolapse. Unfortunately, 5 decisions about hysterectomy may be influenced as much by a woman's race as by objective clinical 6 indications. Despite hysterectomy's prevalence, little is known about how these surgery decisions are made: 7 the existing literature is limited by non-generalizable single-institution studies, racially homogenous samples, 8 inadequate control for symptom severity, and inability to measure the influences of the culture of the healthcare 9 system. The long-term goal of this proposal is to ensure that women of all backgrounds are treated in an 10 equitable manner when it comes to hysterectomy decision-making. To achieve this goal, the objectives of this 11 application are to understand where racial differences in treatment with gynecologic surgery arise and to 12 evaluate the extent to which racial/ethnic differences in hysterectomy treatment constitute surgical disparities. 13 The central hypothesis is that clinical severity will not fully account for all racial/ethnic differences in 14 hysterectomy treatment. We hypothesize that provider-level and practice-level clinical culture can impede 15 equitable dissemination of surgical innovations in hysterectomy. The rationale for the proposed research is that 16 identifying multilevel health care-system influences on hysterectomy receipt will help identify the best targets 17 on which to intervene to achieve equitable surgical care of women's gynecologic conditions. The hypotheses 18 will be tested by pursuing three specific aims: 1) Determine the extent to which the clinical threshold for 19 hysterectomy (uterine weight, pre-operative anemia, pre-operative pain) varies by race/ethnicity; 2) Quantify 20 the extent to which minority patients are differentially likely to be treated by low-volume providers and by 21 practices with high propensity to perform hysterectomy; and 3) Identify drivers of the dissemination of bilateral 22 salpingectomy with ovarian retention (BSOR) at the time of hysterectomy and the extent to which this 23 dissemination varied by race/ethnicity. This approach is innovative because it directly evaluates the 24 longstanding but untested hypothesis that racial differences in clinical severity explain differences in 25 hysterectomy rates. The work also employs an innovative multilevel framework including provider- and 26 practice-level factors. Finally, the work investigates how surgical culture can facilitate or impede the 27 dissemination of a cancer risk-reducing surgical innovation. This work will have sustained impact because it 28 goes beyond documenting racial differences: when this work is completed, we will understand what disparities 29 exist but also how these differences arise. Gynecologic problems are under-investigated relative to their high 30 prevalence, impact on quality of life, and long-term effects of treatment on the health of tens of millions of U.S. 31 women. Fortunately, hysterectomy is both common and amenable to change; therefore, identifying targets to 32 improve equity in the surgery can exert a powerful influence on the gynecologic surgery field. 33 1

1 .项目摘要/摘要