COmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP)

社区参与的血压控制模拟培训 (CONSULT-BP)

• 批准号: 10084714
• 负责人: JENNIFER TJIA
• 金额: $ 74.47万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-19 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10084714
• 关键词: Academic Medical Centers; Accounting; Address; Adherence; Affect; Attitude; Awareness; Blood Pressure; Cardiovascular Diseases; Characteristics; Climate; Clinic; Clinical; Clinical Skills; Cluster randomized trial; Communication; Communication Tools; Communities; Community Participation; Computerized Medical Record; Cultural Sensitivity; Data; Decision Making; Development; Diastolic blood pressure; Diet; E-learning; Education; Educational Curriculum; Educational Intervention; Effectiveness of Interventions; Elements; Ethnic Origin; Evaluation; Evidence based intervention; Exposure to; Faculty; Family Practice; Feedback; Funding; Goals; Health; Health Personnel; Health Services Research; Health system; Healthcare; Hospitals; Hypertension; Institutes; Internal Medicine; Intervention; Knowledge; Lead; Learning; Learning Module; Life Expectancy; Link; Measures; Medicaid; Medical; Medical Education; Minority; Modeling; Modification; Morbidity - disease rate; Needles; Nurse Practitioners; Outcome; Participant; Patient Education; Patient Self-Report; Patient-Focused Outcomes; Patients; Performance; Personal Communication; Persons; Pharmaceutical Preparations; Population; Poverty; Primary Health Care; Process; Provider; Quality of Care; Questionnaires; Race; Randomized; Reporting; Risk Factors; Role; Safety; Schedule; Self Assessment; Self Perception; Standardization; Students; Surveys; Testing; Time; Time trend; Training; Training Support; Trust; Underserved Population; Visit; base; blood pressure reduction; blood pressure regulation; bone; clinical decision-making; clinical encounter; cohort; community based participatory research; comparison intervention; compliance behavior; cultural competence; design; dietary adherence; education research; effectiveness evaluation; ethnic minority population; evidence base; explicit bias; health care disparity; health disparity; hypertension control; implicit bias; improved; innovation; intervention program; medical specialties; medication compliance; member; minority communities; minority health; mortality; patient oriented; patient-clinician communication; poor communities; post intervention; primary outcome; programs; racial and ethnic; racial bias; racial disparity; randomized trial; recruit; safety net; simulation; simulation game; skill acquisition; skills; skills training; socioeconomic disadvantage; theories; trial design; virtual experiments; visit adherence

PROJECT SUMMARY Cardiovascular disease (CVD) is a leading contributor to racial disparities in life expectancy and uncontrolled hypertension is a critical risk factor underlying this disparity. Despite interventions to overcome barriers to hypertension control, accumulating evidence demonstrates that well-meaning, egalitarian providers can harbor implicit biases that affect patient interactions, clinical decision-making, and the effectiveness of interventions to mitigate cross-cultural differences. We propose a program called COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP), a theory-based, multi-component, training intervention that targets medical residents and nurse practitioner students. CONSULT-BP will adapt and test a theory-based, `awareness, exposure and skill-building' intervention, applied in the safety of a simulation-based learning center, to improve providers' interaction skills with minority and poor patients. We will use our established platform of community-based participatory research to implement CONSULT-BP in an academic medical center with a large, safety-net health system that serves a minority and poor population. The CONSULT-BP project will: 1. recruit and hire Community Advisors (CA) representing diverse underserved populations who will participate in the adaptation of evidence-based hypertension communication tools and the design, development, and implementation of the training curriculum; 2. use online self-assessments of clinicians' implicit bias for race and patient compliance to raise bias self-awareness and to examine the effect of bias on knowledge and skill development; and 3. hire Community SPs to (a) conduct face-to-face, simulated clinical encounters with medical trainees and NP students, and (b) provide evaluation and feedback about communication skills along with trained CA observers and faculty facilitators. The educational intervention is a program of two, 90-minute, sessions, spaced 5 weeks apart that combine online learning with in-person skill practice. To understand how much training exposure is required to `move the needle' of clinical skills and patient outcomes, we will assess the effect of CONSULT-BP by conducting two, sequential, randomized trials. Trial 1 will evaluate the effectiveness of one-time CONSULT training on outcomes, and Trial 2 will evaluate the effect of repeat, booster training on outcomes. To support training feasibility in Trial 1, CONSULT-BP will train cohorts of IM, FM, and NP trainees over a 3-year period, and will target advanced (2nd or 3rd-year) trainees within a given academic year for one-time exposure to the training intervention. Within each academic year, we will randomize training times to 1 of 5 start dates using a stepped wedge design to accommodate pre-existing training schedules and to mitigate the effect of temporal trends in clinical skill proficiency. Trial 2 will randomly assign continuing trainee participants from Trial 1 to a second CONSULT-BP booster training exposure versus no booster training. The primary outcome for both trials will be patient BP control. Secondary process outcomes will include trainees' communication skills and patient adherence to medications, visits, and diet changes. We will also examine effect modification by patient characteristics (baseline BP control) and trainee characteristics (implicit bias and awareness of bias). Trainee measures will be from trainee self-report (implicit bias, bias awareness), community SP report (trainee communication skills), and clinic patient surveys (trainee communication quality and patient adherence). Clinical BP outcomes will be from the EMR. We will use analytic mixed effect models accounting for patient and clinician characteristics, patient correlations within randomization clusters and within clinicians, and repeated measures within patient. The CONSULT-BP multi-staged, community-engaged, education model will change how medical educators think about helping providers develop bias-aware, patient-centered, communication skills.

项目摘要 心血管疾病（CVD）是导致预期寿命种族差异的主要原因， 不受控制的高血压是造成这种差异的关键危险因素。尽管采取了干预措施， 高血压控制的障碍，越来越多的证据表明，善意的，平等的提供者 可能隐藏着影响患者互动、临床决策和 采取干预措施，减少跨文化差异。我们提出了一个名为“社区参与”的计划， 血压控制模拟培训（CONSULT-BP），一种基于理论的多组分培训 针对住院医师和执业护士学生的干预。CONSULT-BP将调整和测试 以理论为基础的“认识、接触和技能培养”干预，应用于基于模拟的 学习中心，以提高提供者与少数民族和贫困患者的互动技能。我们将用我们 建立了以社区为基础的参与性研究平台， 学术医疗中心，拥有一个大型的安全网卫生系统，为少数民族和贫困人口服务。的 CONSULT-BP项目将：1.招募和雇用社区顾问（CA），代表各种服务不足的人 将参与调整循证高血压沟通工具的人群， 设计、开发和实施培训课程; 2.使用在线自我评估 临床医生对种族和患者依从性的隐性偏见，以提高偏见的自我意识，并检查 偏见对知识和技能发展的影响; 3.雇用社区SP（a）进行面对面， 与医学实习生和NP学生的模拟临床接触，以及（B）提供评估， 关于沟通技巧的反馈沿着与训练有素的CA观察员和教师辅导员。教育 干预是一个两个，90分钟，会议，间隔5周，结合联合收割机在线学习与 亲自技能实践。为了了解需要多少培训暴露才能“移动针”的临床 技能和患者结局，我们将通过进行两次连续的， 随机试验试验1将评估一次性咨询培训对结局的有效性， 试验2将评估重复强化训练对结果的影响。支持培训的可行性， 试验1，CONSULT-BP将在3年的时间内培训IM、FM和NP学员， 在一个学年内接受一次培训的高级（第二或第三年）学员 干预在每个学年，我们将随机培训时间，以1的5开始日期使用步进 楔形设计，以适应预先存在的培训计划，并减轻时间趋势的影响， 临床技能熟练程度。试验2将从试验1中随机分配继续受训的参与者到第二个 CONSULT-BP助推器培训暴露与无助推器培训。两项试验的主要结局将 耐心控制血压。次级过程成果将包括学员的沟通技巧和耐心 坚持药物治疗、访视和饮食改变。我们还将检查患者的效果修改 特征（基线BP控制）和受训者特征（内隐偏差和偏差意识）。见习 测量将来自受训者自我报告（内隐偏见，偏见意识），社区SP报告（受训者 沟通技巧）和临床患者调查（受训者沟通质量和患者依从性）。 临床BP结局将来自EMR。我们将使用分析混合效应模型来解释患者 和临床医生特征，随机化集群内和临床医生内的患者相关性，以及 在患者体内重复测量。CONSULT-BP多阶段、社区参与的教育模式将 改变医学教育工作者如何看待帮助提供者发展偏见意识，以病人为中心， 沟通能力

项目成果

Using Simulation-Based Learning with Standardized Patients (SP) in an Implicit Bias Mitigation Clinician Training Program.

• DOI: 10.1177/23821205231175033
• 发表时间: 2023-01
• 期刊: JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT
• 影响因子: 2.8
• 作者: Tjia, Jennifer;Pugnaire, Michele;Calista, Joanne;Eisdorfer, Ethan;Hale, Janet;Terrien, Jill;Valdman, Olga;Potts, Stacy;Garcia, Maria;Yazdani, Majid;Puerto, Geraldine;Okero, Miriam;Duodu, Vennesa;Sabin, Janice
• 通讯作者: Sabin, Janice

COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP): A study protocol.

• DOI: 10.1097/md.0000000000023680
• 发表时间: 2021-02-05
• 期刊: Medicine
• 影响因子: 1.6
• 作者: Tjia J;Pugnaire M;Calista J;Esparza N;Valdman O;Garcia M;Yazdani M;Hale J;Terrien J;Eisdorfer E;Zolezzi-Wyndham V;Chiriboga G;Rappaport L;Puerto G;Dykhouse E;Potts S;Sifuentes AF;Stanhope S;Allison J;Duodo V;Sabin J
• 通讯作者: Sabin J

Perspectives of Community Partners Involved in an Academic Training to Address Clinicians' Implicit Bias.

参与学术培训以解决临床医生隐性偏见的社区合作伙伴的观点。

• DOI: 10.1353/cpr.2023.a900215
• 发表时间: 2023
• 期刊: Progress in community health partnerships : research, education, and action
• 作者: Calista,Joanne;Esparza,Nancy;Fernandez,Jaenia;Beltran,Axel;Bradshaw,Jacqueline;Casseres,Alfredo;Duodu,Samuel;Duodu,Vennesa;Fordjour,Charles;Kuffour,Benetta;Mensah,Linda;Negrón-Cruz,Leopoldo;Pietri,Carlos;Pridgen,Cora;Puerto,Ge
• 通讯作者: Puerto,Ge