Improving Clinical Encounter Communications to Enhance Minority Diabetes Care

 描述(由申请人提供)：在医疗保健提供和结果方面的差异在一定程度上与医生在与种族、民族和经济状况不同的患者建立有效沟通方面的困难有关。2型糖尿病和糖尿病前期营养性肥胖就是一个重要的例子。种族和社会经济差异可能会阻碍医生理解患者的限制性现实，例如在购买食品和药物等日常活动中涉及的复杂权衡和决策策略。当有关糖尿病诊断和治疗的临床会面没有针对患者的实际情况量身定做时，它们变得不太可能导致对需要做什么的共同理解。反过来，这可能会导致医生认为少数族裔患者不服从，无视他们的建议。为了有效，这些基于接触的关于护理、行为和自我护理的讨论需要一种对话，以适应个体患者的文化假设、认知/情感关切和系统性社会经济约束。这一领域需要改进--治疗受健康差距影响的人群的临床医生必须具备了解如何根据这些患者的独特需求制定和调整他们的对话的能力。我们设想的系统--通过援助和培训(重复)实现增强的患者接触--将为当前(非常少的)培训提供一个创新的替代方案。它将最佳实践封装在一个基于经验学习的低成本、无处不在的可访问系统中。Repeat将提供一个逼真的虚拟环境，允许通过与合成标准化患者(SSP)的模拟交互来学习。这些是交互式计算机生成的化身，可以在办公室内真实地(通过语言和非语言)对临床医生的交流做出行动和反应 参观。新兴的认知模拟技术将为SSP注入代表特定患者亚群的共同特征的属性(例如，环境和经济限制、信念、态度、恐惧)。第一阶段建立了一个初步的重复原型，作为一组有限的虚拟临床接触，并使用毕业医学生的样本对其进行了实验评估。评估显示，在Repeat的主动辅导、反应性反馈和其他形式的辅导指导下，仅在重复虚拟会面中练习了几个小时后，沟通能力就有了显著改善(使用多种测量方法)。第二阶段将开发一套完整的课程，传授必要的知识和技能，让患有T2D或糖尿病前期肥胖症的低收入非裔美国人参与进来，并有效地使治疗计划适应他们面临的社会经济障碍。第二阶段还将开发可商业化的软件工具，以创建和提供这一课程和其他重复课程。这项技术有可能被广泛使用，包括患者可以使用的版本，并通过改善提供者和患者之间的沟通来减少医疗保健差距。

 DESCRIPTION (provided by applicant): Disparities in healthcare delivery and outcomes have been linked, in part, to the difficulties physicians have in establishing effective communication with patients who differ from themselves in terms of race, ethnicity and economic circumstances. Type 2 diabetes mellitus and pre-diabetic nutrition-based obesity are an important case in point. Racial and socio-economic differences can impede doctors' ability to understand their patients' constraining realities, such as the complex tradeoffs and decision strategies involved in daily activities like purchasing food and medications. When clinical encounters about diabetes diagnosis and management are not tailored to the patient's pragmatic realities, they become less likely to lead to a shared understanding of what needs to be done. This can, in turn, lead physicians to perceive that minority patients are non-compliant and ignoring their advice. To be effective, these encounter-based discussions about care, behavior, and self-care require a dialog that is adaptive to the cultural assumptions, cognitive/emotional concerns, and systemic socio- economic constraints of the individual patient. This area is in need of improvement - clinicians treating populations affected by health disparities must possess the competencies to understand how to frame and tailor their dialogs to the unique needs of these patients. The system we envision-Realizing Enhanced Patient Encounters through Aiding and Training (REPEAT) - will provide an innovative alternative to current (very minimal) training. It encapsulates best practices in a low cost, ubiquitously accessible system based on experiential learning. REPEAT will offer a realistic virtual environment that allows learning to occur through simulated interactions with synthetic standardized patients (SSPs). These are interactive computer-generated avatars that can act and react realistically (via verbal and via nonverbal) to clinician communications during an office visit. Emerging cognitive simulation technology will imbue the SSPs with attributes (e.g., environmental and economic limitations, beliefs, attitudes, fears) that are representative of shared characteristics of a specific patient subpopulation. Phase I built a preliminary REPEAT prototype as a limited set of virtual clinical encounters and experimentally assessed it using a sample of graduating medical students. The assessment showed significant improvement in communication performance (using multiple measures) after only a few hours of practice in REPEAT virtual encounters as guided by REPEAT's proactive coaching, reactive feedback and other forms of tutoring. Phase II will develop a full curriculum to teach knowledge and skills needed to engage low income African Americans with T2D or pre-diabetic obesity and productively adapt treatment plans to the socio-economic barriers they face. Phase II will also develop commercializable software tools to create and deliver this and other REPEAT curricula. The technology has the potential to be translated to broad usage, including a version usable by patients, and to reduce healthcare disparities by improving communication among providers and patients.