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Implicit racial bias in pediatric emergency medicine: A foundational investigation of physician behaviors

儿科急诊医学中的隐性种族偏见：对医生行为的基础调查

基本信息

批准号：
10722681
负责人：
Colleen Kays Gutman
金额：
$ 15.56万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-11 至 2028-02-29
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10722681
关键词：
Accident and Emergency department Address Affect Analgesics Antibiotics Area Asthma Attitude Award Awareness Behavior Caring Characteristics Child Child Care Child Health Child Rearing Code Communication Complement Complex Consensus Craniocerebral Trauma Data Decision Making Delphi Technique Development Development Plans Educational Intervention Elements Emergency Care Emergency Department Physician Emergency Medicine Emergency Situation Emergency department visit Environment Equity Ethnic Origin Family Florida Foundations Funding Future Goals Head Health Disparities Research Heart Arrest Image Individual Inequity Intervention Intervention Studies Interview Investigation Judgment Knowledge Language Leadership Linear Models Measurement Mediating Mediation Mediator Medical Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methods Minority Minority Groups National Center for Advancing Translational Sciences National Institute on Minority Health and Health Disparities Not Hispanic or Latino Outcome Parents Patient-Focused Outcomes Patients Perception Physicians Prejudice Questionnaires Race Research Resources Risk Science Scientist Sepsis Severity of illness Stereotyping Stress Uncertainty Unconscious State United States Universities Video Recording Writing behavior change career development cognitive load communication behavior design disorder control disparity reduction effective intervention experience health communication health disparity health literacy high risk implicit bias marginalization minority children multidisciplinary outcome disparities patient oriented pediatric emergency professor prospective provider behavior racial bias racism response self-reported anxiety shared decision making skills social factors unconscious bias

项目摘要

PROJECT SUMMARY/ABSTRACT In the pediatric emergency department, children who belong to racial, ethnic, and language minority groups are less likely to receive interventions such as antibiotics and pain medication. Importantly, minority children are more likely to die of emergency conditions, including sepsis and cardiac arrest. Eliminating inequity requires strategic and rigorous approaches across multiple levels. Dr. Colleen Gutman is an Assistant Professor of Pediatric Emergency Medicine at the University of Florida. Her long-term goal is to become an independently funded physician-scientist with a focus on investigating and implementing strategies to promote equitable, patient-centered pediatric emergency care. Through the support of a KL2 award, Dr. Gutman gained introductory skills in multi-center health disparities research, qualitative analysis, and health communication science. To achieve a successful transition to research independence, Dr. Gutman and her multidisciplinary mentorship team devised a career development plan that builds from that foundation. With this K23 award, Dr. Gutman will develop advanced skills in 1) the identification and measurement of implicit bias, 2) the science of patient-centered communication, 3) advanced mixed methods, 4) academic leadership, and 5) scientific writing. The career development plan will be complemented by mentored research experiences. Using the NIMHD Research Framework, the proposed research seeks to define elements of the physician-parent interaction that contribute to child health disparities. The objective is to define how implicit bias affects physician behavior in the pediatric emergency department. This is a necessary first step that will inform targeted interventions aimed at reducing child health disparities. In Aim 1, Dr. Gutman will use a parent- engaged modified Delphi approach to establish physician behaviors (e.g., assumptions about parent characteristics and access to resources; communication with parents) that may mediate the relationship between physician implicit bias and child health disparities. In Aim 2, she will collect paired questionnaires from pediatric emergency physicians and parents. She will analyze physician-parent response concordance on items evaluating parent characteristics and access to resources. Through this analysis, she will assess for systematic differences in the accuracy of physician assumptions based on parent race, ethnicity, and language. In Aim 3, she will video-record pediatric emergency department encounters to analyze the relationship between physician communication and parent race, ethnicity, and language. Physician behaviors that differ for minority parents may mediate the relationship between physician implicit bias and child health disparities. The findings will inform a multicenter R01 proposal that is fully powered to conduct a mediation analysis assessing the relative importance of the defined behaviors on patient-centered disparities outcomes. Long term, this research will inform targeted interventions to reduce disparities in child health.

项目概要/摘要在儿科急诊科，属于种族、民族和语言少数群体的儿童接受抗生素和止痛药等干预措施的可能性较小。重要的是，少数民族儿童更有可能死于紧急情况，包括败血症和心脏骤停。消除不平等需要跨多个层面的战略和严格方法。科琳·古特曼博士是助理教授佛罗里达大学的儿科急诊医学。她的长期目标是成为一个独立的人资助的医师科学家，重点是调查和实施促进公平、以患者为中心的儿科急诊护理。通过 KL2 奖项的支持，古特曼博士获得了多中心健康差异研究、定性分析和健康沟通的入门技能科学。为了成功过渡到研究独立性，古特曼博士和她的多学科导师团队在此基础上制定了职业发展计划。凭借此 K23 奖，Dr. 古特曼将发展以下方面的高级技能：1）识别和测量隐性偏见，2）科学以患者为中心的沟通，3）先进的混合方法，4）学术领导力，5）科学写作。职业发展计划将得到指导研究经验的补充。使用 NIMHD 研究框架，拟议的研究旨在定义医生-父母的要素导致儿童健康差异的相互作用。目的是定义隐性偏见如何影响儿科急诊科的医生行为。这是必要的第一步，将告知旨在减少儿童健康差距的有针对性的干预措施。在目标 1 中，古特曼博士将使用家长- 采用修改后的德尔菲法来建立医生行为（例如，关于父母的假设）特征和资源获取途径；与父母的沟通）可能会调解关系医生隐性偏见与儿童健康差异之间的关系。在目标 2 中，她将收集配对问卷儿科急诊医生和家长。她将分析医生与家长的反应一致性评估父母特征和资源获取情况的项目。通过这一分析，她将评估基于父母种族、民族和文化的医生假设的准确性存在系统性差异语言。在目标 3 中，她将对儿科急诊科的遭遇进行视频记录，以分析医生沟通与父母种族、民族和语言之间的关系。医生行为少数族裔父母的不同可能会调节医生隐性偏见与儿童健康之间的关系差异。研究结果将为多中心 R01 提案提供信息，该提案完全有能力进行调解评估特定行为对以患者为中心的差异结果的相对重要性的分析。从长远来看，这项研究将为有针对性的干预措施提供信息，以减少儿童健康方面的差异。