Measuring Cultural Competence and Racial Bias Among Physicians

描述(由申请人提供)：新出现的证据表明，医患关系中的种族障碍可能是卫生保健质量差异的一个重要来源。这些障碍包括医生和患者之间的文化差异；与其他种族或民族的人交往时的社会不适或不信任(“种族间焦虑”)；以及医生对少数族裔患者的负面种族偏见或成见。“文化能力”培训已成为减少病人和医生之间种族障碍影响的主要手段。然而，到目前为止，关于文化能力培训内容的实证证据有限。具体地说，关于医患关系中特定种族障碍的性质和影响，以及减少这些障碍所需的知识、态度和技能的研究很少。这项发展赠款申请的目的是开发和测试必要的工具，以衡量医患关系中的种族障碍和文化能力，作为评估它们在造成和减轻保健质量和结果方面的种族差异方面的作用的第一步。我们的具体目标是：1)开发一种测量医生文化能力的心理测量学工具；2)测试测量医生种族间焦虑的量表的可靠性和有效性；以及3)测试一种测量医生种族偏见的计算机化、交互式工具的有效性。我们将使用多步骤的方法来实现这些目标，包括对调查草案进行专家科学审查，对执业医生进行认知访谈，进行全国医生调查，以及心理测量学分析。开发和测试医患关系中的文化能力和种族障碍的措施将提供必要的工具，以推动卫生保健中种族差异的研究。这些措施将至少起到三个关键作用。首先，它们将使我们能够经验性地评估医生偏见以及医患关系中的其他种族障碍在解释医疗质量差异方面的作用。其次，它们将使我们能够确定文化能力这一广泛概念的哪些方面(如果有的话)减少了种族障碍，进而缩小了医疗保健差距。这两个步骤将有助于了解文化能力培训和其他干预措施的内容，以减少差异。最后，严格制定的种族障碍和文化能力衡量标准将为判断文化能力项目的有效性提供必要的评估工具，其中许多项目目前正在NIH的赞助下开发。该项目的目的是开发和测试必要的工具，以探索医患关系中种族障碍作为卫生保健质量差异的根源所起的作用，以及医生的文化能力作为减轻这些障碍的手段所起的作用。需要这些工具来通报和评估未来的干预措施，以减少卫生保健质量和结果中普遍存在的种族差异。

DESCRIPTION (provided by applicant): Emerging evidence suggests that racial barriers in the patient-physician relationship may be an important source of disparities in the quality of health care. These barriers include cultural dissimilarity between doctors and patients; social discomfort or distrust when interacting with people from other racial or ethnic groups ("interracial anxiety"); and negative racial bias or stereotyping of minority patients by physicians. Training in "cultural competence" has become the primary vehicle for reducing the impact of racial barriers betweens patients and physicians. To date, however, there has been limited empirical evidence to inform the content of cultural competence training. Specifically, there has been scant research on the nature and influence of specific racial barriers in the patient-physician relationship, and on the knowledge, attitudes, and skills needed to reduce them. The objective of this developmental grant application is to develop and test tools necessary to measure racial barriers and cultural competence in the patient-physician relationship, as a first step towards assessing their role in causing and mitigating, respectively, racial disparities in health care quality and outcomes. Our specific aims are to: 1) develop a psychometrically sound instrument measuring cultural competence among physicians; 2) test the reliability and validity of scales measuring interracial anxiety among physicians; and 3) test the validity of a computerized, interactive tool measuring racial bias among physicians. We will use a multi-step approach to achieve these aims, including expert scientific review of draft survey items, cognitive interviews with practicing physicians, a national physician survey, and psychometric analysis. Developing and testing measures of cultural competence and racial barriers in the patient-physician relationship will provide essential tools necessary to advance the study of racial disparities in health care. These measures will serve at least three crucial functions. First, they will allow us to empirically assess the role of physician bias, and other racial barriers in the patient-physician relationship, in explaining disparities in the quality of health care. Second, they will allow us to determine which (if any) facets of the broad concept of cultural competence reduce racial barriers and in turn reduce health care disparities. Both of these steps will help inform the content of cultural competence training and other interventions to reduce disparities. Finally, rigorously developed measures of racial barriers and cultural competence will provide needed evaluation tools for judging the effectiveness of cultural competence programs, many of which are currently being developed under NIH sponsorship. The aims of this project are to develop and test tools needed to explore the role of racial barriers in the patient- physician relationship as a source of disparities in the quality of health care, and the role of cultural competence among physicians as a means to mitigate those barriers. These tools are needed to inform and evaluate future interventions to reduce pervasive racial disparities in health care quality and outcomes.