The Impact of Surgeon Factors and Education/Training on Disparities in Surgical Care.

外科医生因素和教育/培训对外科护理差异的影响。

• 批准号: 10560646
• 负责人: Yusuke Tsugawa
• 金额: $ 62.75万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-12 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10560646
• 关键词: Affect; Age; American College of Surgeons; American Medical Association; Association of American Medical Colleges; Awareness; Black race; Caring; Characteristics; Data; Data Set; Databases; Disparity; Education; End stage renal failure; Environment; Ethnic Origin; Faculty; Failure; Fibrinogen; Funding; Gender; Health Services Research; Hispanic; Individual; Instruction; International; Intervention; Kidney Transplantation; Knowledge; Language; Lead; Length of Stay; Life; Link; Location; Mastectomy; Medical Residency; Medicare; Methods; Minority; Minority Health Research; Modeling; Morbidity - disease rate; Operative Surgical Procedures; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Physicians; Play; Positioning Attribute; Process; Public Health; Quality of Care; Race; Research; Research Personnel; Residencies; Resources; Role; Rural; Schools; Socioeconomic Status; Strategic Planning; Students; Surgeon; System; Testing; Training and Education; Transplant Recipients; United States National Institutes of Health; Variant; beneficiary; care costs; continuing medical education; cultural competence; disparity gap; ethnic disparity; ethnic minority; evidence base; experience; health literacy; hospital readmission; improved; innovation; medical schools; minority health; minority health disparity; minority patient; mortality; nonEnglish language; novel strategies; peer; programs; provider factors; racial disparity; racial minority; reconstruction; statistics; surgical disparities; symposium; therapy design; urban area

Project Summary Evidence indicates that racial and ethnic minority patients undergoing surgery receive worse quality care and experience worse outcomes than White patients do in the U.S. “Clinician factors” are one of five key determinants of surgical disparities identified at the National Institutes of Health and American College of Surgeons Summit in 2015. However, little is known about the characteristics of surgeons who deliver high- quality care to racial and ethnic minority patients, and whether education and training surgeons received affect surgical disparities. These knowledge gaps have hindered efforts to develop interventions that can effectively close the disparity gap in surgical care. The proposed R01 project will create a comprehensive, multi-level database that includes detailed information about patients, surgeons, medical schools surgeons attended, and residency programs surgeons completed, by linking four large, nationally-representative datasets: (1) Medicare data, (2) comprehensive physician database assembled by Doximity, (3) the AAMC Medical School database, and (4) the AMA Residency database. In Aim 1, using this innovative dataset, we will examine whether surgical care (i.e., processes of care, patient outcomes, and utilizations) differ between Black or Hispanic patients versus White patients when they are treated by the same surgeons using multi-level regression models. In Aim 2, we will identify individual characteristics of surgeons (e.g., age, gender, whether surgeons speak languages other than English, and the proportion of patients treating who are racial/ethnic minorities [“minority-serving surgeons”]) that are associated with racial/ethnic disparities in surgical care. Finally, using the information on the characteristics of medical schools and residency programs collected by AAMC and AMA, Aim 3 will determine whether the characteristics of medical schools (e.g., the proportion of racial/ethnic minority faculty/students, the percentage of international students, location in rural vs. urban areas) and residency programs (e.g., the proportion of racial and ethnic minority faculty/students/patients, the presence of cultural competence awareness program, instruction in non-English languages) related to cultural competency lead to improved surgical care received by racial and ethnic minority patients. The proposed R01 project will provide a unique opportunity to advance the field by better understanding the mechanisms of disparities related to surgeon factors, and will identify potentially modifiable attributes of surgeons, medical schools, and residency programs that contribute to disparities in surgical care. This project will provide a strong evidence base for developing interventions, such as evidence-based cultural competency programs and Continuing Medical Education, which can effectively reduce racial and ethnic disparities in surgical care. The research team consists of multiple NIH-funded researchers with expertise in all relevant fields (health services research, disparity research, surgical education, and statistics) to conduct this innovative research. The proposed study aligns well with the NIH strategic plan for research in minority health and health disparities.

项目摘要 证据表明，接受手术的种族和少数民族患者接受质量较差的护理和 在美国，经历比白人患者的结果更糟糕的结果是“临床医生因素”是五个关键 美国国立卫生研究院和美国学院确定的手术差异的决定因素 但是，2015年的外科医生峰会。但是，对提供高的外科医生的特征知之甚少。 对种族和少数民族患者的优质护理，以及教育和培训外科医生是否受到影响 手术分布。这些知识差距阻碍了开发干预措施的努力 缩小手术护理中的差异差距。拟议的R01项目将创建一个全面的多层次 包括有关患者，外科医生，医学院外科医生参加的详细信息的数据库以及 外科医生通过链接四个全国代表性数据集完成了外科医生：（1）Medicare 数据，（2）由Doximity组装的全面物理数据库，（3）AAMC医学院数据库， （4）AMA居住数据库。在AIM 1中，使用此创新数据集，我们将检查是否是否 黑人或西班牙裔之间的手术护理（即护理过程，患者结果和利用过程）有所不同 患者与白人患者使用多层次回归治疗同一外科医生治疗时 型号。在AIM 2中，我们将确定外科医生的个体特征（例如，年龄，性别，外科医生是否 说英语以外的其他语言，以及治疗种族/族裔少数民族的患者的比例 [“少数派服务外科医生”]）与外科护理中的种族/种族差异有关。最后，使用 AAMC和 AMA，AIM 3将确定医学院的特征（例如种族/种族的比例 少数派教职员工，国际学生的百分比，在农村与城市地区的地点）和 居住计划（例如，种族和少数民族教师/学生/患者的比例 文化能力意识计划，非英语语言的说明）与文化能力有关 导致种族和少数民族患者接受的改善手术护理。拟议的R01项目将 通过更好地理解分布的机制，提供了一个独特的机会来推进该领域 与外科医生的因素有关，并将确定外科医生，医学院和 导致外科护理差异的居住计划。该项目将提供有力的证据 开发干预措施的基础，例如基于证据的文化能力计划和继续 医学教育可以有效地减少外科手术护理中的种族和种族差异。研究 团队由NIH资助的多个具有专业知识的研究人员组成（健康服务研究， 差异研究，外科教育和统计数据）进行了这项创新研究。拟议的研究 与NIH少数民族健康和健康分配研究的NIH战略计划非常相吻合。