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

项目摘要/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，少数族裔儿童 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 跨多个层面的战略性和严谨的方法。科琳·古特曼博士是麻省理工学院 佛罗里达大学的儿科急诊医学。她的长期目标是成为一名独立的 资助医生和科学家，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救。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、定性分析和健康传播方面的入门技能 科学。为了实现向研究独立性的成功过渡，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。有了这个K23奖项，Dr。 古特曼将在1)内隐偏见的识别和测量，2)内隐偏见的科学 以患者为中心的交流，3)先进的混合方法，4)学术领导，5)科学 写作。职业发展计划将得到有指导的研究经验的补充。使用 NIMHD研究框架，这项拟议的研究试图定义医生-父母的要素 造成儿童健康差距的相互作用。其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，它将使 旨在减少儿童健康差距的有针对性的干预。在《目标1》中，古特曼博士将用一位家长- 采用改进的Delphi方法来确定医生的行为(例如，对父母的假设 特征和对资源的访问；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距之间的关系。在目标2中，她将从以下位置收集配对问卷 儿科急诊医生和家长。她将分析医生和父母的反应一致性 评估父特征和资源访问权限的项。通过这一分析，她将评估 基于父母种族、民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，她将拍摄儿科急诊科的遭遇，以分析 医生沟通与父母种族、民族、语言的关系。医生行为 对于少数族裔父母来说，这一差异可能在医生内隐偏见和儿童健康之间的关系中起到了中介作用 差距。调查结果将为多中心R01提案提供信息，该提案完全有权进行调解 评估已定义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，这项研究将为减少儿童健康方面的差异提供有针对性的干预措施。

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.