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

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 不太可能接受抗生素和止痛药等干预措施。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 在多个层面采取战略性和严格的方法。科琳·古特曼博士是一名助理教授， 佛罗里达大学儿科急诊医学。她的长期目标是成为一名独立的 资助的医生，科学家，重点是调查和实施战略，以促进公平， 以病人为中心的儿科急诊通过KL 2奖的支持，古特曼博士获得了 多中心健康差异研究，定性分析和健康传播的入门技能 科学为了实现向研究独立的成功过渡，古特曼博士和她的多学科 指导小组在此基础上制定了职业发展计划。凭借K23奖，博士 古特曼将在1）内隐偏见的识别和测量，2） 以病人为中心的沟通，3）先进的混合方法，4）学术领导，5）科学 写作职业发展计划将辅之以指导性的研究经验。使用 NIMHD研究框架，拟议的研究旨在定义医生父母的要素 这种相互作用造成儿童健康差距。目的是确定内隐偏见如何影响 儿科急诊科的医生行为。这是必要的第一步， 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，古特曼博士将使用父母- 采用改良的德尔菲法建立医生行为（例如，关于父母的假设 特征和获得资源的途径;与父母的沟通），这可能会调解关系 医生内隐偏见和儿童健康差异之间的关系。在目标2中，她将收集来自 儿科急诊医生和家长。她将分析医生-家长反应的一致性， 评估父特性和资源访问的项目。通过这种分析，她将评估 基于父母种族、种族和性别的医生假设准确性的系统性差异 语言在目标3中，她将视频记录儿科急诊科的遭遇，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 不同的少数民族父母可能介导医生的内隐偏见和儿童健康之间的关系 差距。这些发现将为多中心R 01提案提供信息，该提案完全有能力进行调解 分析评估定义的行为对以患者为中心的差异结果的相对重要性。 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距。

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.