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.