Developing Novel Linguistic Analytic Methods to Optimize Relationship Quality and Equity in HIV Care

项目摘要 包括艾滋病毒护理在内的多个疾病领域的证据表明，更高质量的患者-临床医生 沟通和关系极大地改善了患者的健康状况。同样众所周知的是， 种族和少数民族--尤其是非洲裔美国人--的参与率一直较低 艾滋病毒治疗、开处方和坚持使用抗逆转录病毒药物，发病率和死亡率较高。 有证据表明，这些差异可能部分是由于人际关系中的种族/民族差异和 艾滋病毒临床医生和患者之间的沟通，这是一个潜在的可补救的医疗保健来源 不平等。我们项目的目标是开发创新、有效和可扩展的测量和分析 更好地理解患者与医生之间的相互作用的方法可以指导 改善提供的护理质量的干预措施。 这一建议侧重于交际的两个创新特征：语言风格匹配和语言 住宿。LSM是指参与者倾向于使用共同的词汇和言语结构，而 语言顺应是对话中的参与者调整他们的语言的过程 其他参与者的讲话风格。尽管目前有许多测量方面的方法 在患者与临床医生的交流中，到目前为止还没有研究探索LSM和语言的作用 住宿。两者都有希望成为导致更大社会/文化距离的潜在机制 较低质量的关系和结果。因此，我们的具体目标是：(1)应用计算机文本 对临床医患互动记录的分析工具，以生成LSM和语言学的新测量 适应HIV护理，(2)评估LSM和语言学的收敛和预测效度 适应艾滋病毒的结果，以及(3)定性地探索LSM和LSM分别高和低的就诊实例 提供者的语言风格维度与关系质量的高低相关联。 有必要更好地了解艾滋病毒护理中医患互动的动态，以了解 艾滋病毒护理质量和公平性的持续改善。这里概述的创新方法可以：1)阐明 艾滋病毒临床医生可以更有效地沟通和减少种族/民族差异的机制 HIV结果，2)为新的传播分析方法提供初步的有效性证据，3)扩展 医患互动的沟通分析研究的成本效益和规模，以及4)提供 指导为艾滋病毒临床医生建立实时反馈系统，以随着时间的推移改善他们的互动。

Project Summary Evidence across multiple disease areas including HIV care demonstrates that higher quality patient-clinician communication and relationships substantially improves patient health outcomes. It is also well-established that racial and ethnic minorities - African Americans in particular - have consistently lower rates of being engaged in HIV care, be prescribed and adhere to antiretroviral medications, and have higher morbidity and mortality. Evidence suggests that these disparities may rise in part from racial/ethnic differences in relationships and communication between HIV clinicians and patients, which are a potentially remediable source of healthcare inequities. The goal of our project is to develop innovative, valid and scalable measurement and analytic approaches for better understanding of patient-physician interactions that can guide development of interventions to improve the quality of care delivered. This proposal focuses on two innovative features of communication: linguistic style matching (LSM) and linguistic accommodation. LSM is the tendency of participants to use a common vocabulary and speech structure, while linguistic accommodation is the process by which participants in a conversation adjust their language according to the speech style of the other participant. Although there are currently many methods for measuring aspects of patient-clinician communication, no studies to date have explored the role of LSM and linguistic accommodation. Both hold promise as potential mechanisms by which greater social/cultural distance can result in lower quality relationships and outcomes. Accordingly, our specific aims are: (1) Apply computerized text analysis tools to transcripts of clinician-patient interactions to generate novel measures of LSM and linguistic accommodation in HIV care, (2) Evaluate the convergent and predictive validity of LSM and linguistic accommodation to HIV outcomes, and (3) Qualitatively explore examples of visits with high and low LSM and with provider linguistic style dimensions associated with high and low relationship quality. A better understanding of the dynamics of physician and patient interaction in HIV care is necessary to inform continued improvements in HIV care quality and equity. The innovative approach outlined here can: 1) elucidate mechanisms by which HIV clinicians can communicate more effectively and reduce racial/ethnic disparities in HIV outcomes, 2) provide initial validity evidence for a novel communication analytic methods, 3) expand the cost-effectiveness and scale of communication analysis studies of physician-patient interaction, and 4) provide guidance on building real-time feedback systems for HIV clinicians to improve their interactions over time.