Improving Clinical Encounter Communications to Enhance Minority Diabetes Care

改善临床交流以加强少数糖尿病护理

• 批准号: 9306184
• 负责人: WAYNE W ZACHARY
• 金额: $ 75.6万
• 依托单位: STARSHIP HEALTH TECHNOLOGIES
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-13 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9306184
• 关键词: Active Learning; Active Listening; Address; Affect; African American; Area; Attitude; Behavior; Belief; Benchmarking; Caring; Certification; Characteristics; Clinical; Clinical effectiveness; Cognitive; Communication; Competence; Complex; Computer software; Custom; Development; Diabetes Mellitus; Diagnosis; Economics; Educational Curriculum; Effectiveness; Emotional; Encapsulated; Ethnic Origin; Face; Feedback; Food; Fright; Hour; Individual; Instruction; Knowledge; Lead; Learning; Link; Low income; Measures; Medical Education; Medical Students; Medicine; Methods; Minority; Non-Insulin-Dependent Diabetes Mellitus; Nurses; Obesity; Office Visits; Outcome; Patients; Performance; Personal Communication; Pharmaceutical Preparations; Phase; Physicians; Population; Process; Provider; Race; Research; Sampling; Science; Self Care; Services; Software Tools; Standardization; System; Teaching Method; Technology; Training; Translating; Translations; Virtual Library; apprenticeship; base; career; clinical translation; commercial application; commercialization; computer generated; continuing medical education; cost; cultural competence; curriculum development; design; diabetes management; evidence base; experimental study; formative assessment; handheld mobile device; health care delivery; health care disparity; health disparity; improved; improved outcome; individual patient; innovation; insight; instructor; learning progression; learning strategy; new technology; non-compliance; nutrition; pedagogical content; phase 1 study; prototype; public health relevance; scaffold; simulation; skill acquisition; skills; skills training; socioeconomics; technological innovation; technology development; tool; treatment planning; tutoring; undergraduate student; usability; virtual; virtual reality

 DESCRIPTION (provided by applicant): Disparities in healthcare delivery and outcomes have been linked, in part, to the difficulties physicians have in establishing effective communication with patients who differ from themselves in terms of race, ethnicity and economic circumstances. Type 2 diabetes mellitus and pre-diabetic nutrition-based obesity are an important case in point. Racial and socio-economic differences can impede doctors' ability to understand their patients' constraining realities, such as the complex tradeoffs and decision strategies involved in daily activities like purchasing food and medications. When clinical encounters about diabetes diagnosis and management are not tailored to the patient's pragmatic realities, they become less likely to lead to a shared understanding of what needs to be done. This can, in turn, lead physicians to perceive that minority patients are non-compliant and ignoring their advice. To be effective, these encounter-based discussions about care, behavior, and self-care require a dialog that is adaptive to the cultural assumptions, cognitive/emotional concerns, and systemic socio- economic constraints of the individual patient. This area is in need of improvement - clinicians treating populations affected by health disparities must possess the competencies to understand how to frame and tailor their dialogs to the unique needs of these patients. The system we envision-Realizing Enhanced Patient Encounters through Aiding and Training (REPEAT) - will provide an innovative alternative to current (very minimal) training. It encapsulates best practices in a low cost, ubiquitously accessible system based on experiential learning. REPEAT will offer a realistic virtual environment that allows learning to occur through simulated interactions with synthetic standardized patients (SSPs). These are interactive computer-generated avatars that can act and react realistically (via verbal and via nonverbal) to clinician communications during an office visit. Emerging cognitive simulation technology will imbue the SSPs with attributes (e.g., environmental and economic limitations, beliefs, attitudes, fears) that are representative of shared characteristics of a specific patient subpopulation. Phase I built a preliminary REPEAT prototype as a limited set of virtual clinical encounters and experimentally assessed it using a sample of graduating medical students. The assessment showed significant improvement in communication performance (using multiple measures) after only a few hours of practice in REPEAT virtual encounters as guided by REPEAT's proactive coaching, reactive feedback and other forms of tutoring. Phase II will develop a full curriculum to teach knowledge and skills needed to engage low income African Americans with T2D or pre-diabetic obesity and productively adapt treatment plans to the socio-economic barriers they face. Phase II will also develop commercializable software tools to create and deliver this and other REPEAT curricula. The technology has the potential to be translated to broad usage, including a version usable by patients, and to reduce healthcare disparities by improving communication among providers and patients.

 描述（由应用程序提供）：医疗保健分娩和结果的差异部分与医生在与种族，种族和经济环境方面与与自己不同的患者建立有效的患者的困难。 2型糖尿病和基于糖尿病前营养前的肥胖是一个重要的例子。种族和社会经济差异可能会阻碍医生理解其患者的约束现实的能力，例如复杂的折衷方案和日常活动涉及的决策策略，例如购买食品和药物。当临床遇到有关糖尿病诊断和管理的临床遇到并不是针对患者的实用现实量身定制的，它们就不太可能导致对需要做的事情的共同理解。反过来，这可以使医生认为少数族裔患者不合规，而忽略了他们的建议。为了有效，这些基于相遇的关于护理，行为和自我护理的讨论需要适应文化假设，认知/情感关注以及个人患者的系统性社会经济约束。该领域需要改进 - 治疗受健康差异影响的人群的临床医生必须具备了解如何构架和量身定制对话的能力，以满足这些患者的独特需求。我们设想通过帮助和培训（重复）实现增强的患者的系统将提供创新的替代方法，以进行当前（非常最小）培训。它将基于专家学习的低成本，普遍访问的系统封装在最佳实践中。重复将提供一个现实的虚拟环境，可以通过与合成标准化患者（SSP）进行模拟相互作用进行学习。这些是交互式计算机生成的化身，可以在办公室期间对临床通信采取现实和反应（通过口头和非语言） 访问。新兴的认知模拟技术将使SSP具有代表特定患者亚人群的共同特征的属性（例如环境和经济局限性，相信，参加，恐惧）。第一阶段建立了初步重复原型作为有限的虚拟临床相遇，并使用渐变医学生样本对其进行了实验评估。该评估显示，在重复虚拟遭遇中仅几个小时的练习后，在重复的主动辅导，反应性反馈和其他形式的辅导中，沟通绩效（使用多种措施）的显着改善。第二阶段将开发一门完整的课程，以教授具有T2D或糖尿病前肥胖症的低收入非裔美国人所需的知识和技能，并为他们面临的社会经济障碍提供有效的治疗计划。第二阶段还将开发可商业化的软件工具来创建和提供此和其他重复课程。该技术有可能转化为广泛的用法，包括患者可用的版本，并通过改善提供者和患者之间的沟通来减少医疗保健分配。