Improving Clinical Encounter Communications to Enhance Minority Diabetes Care

 描述（由申请人提供）：医疗服务和结局的差异部分与医生难以与种族、民族和经济状况不同的患者建立有效沟通有关。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了解患者的限制性现实的能力，例如购买食物和药物等日常活动中涉及的复杂权衡和决策策略。当糖尿病诊断和管理的临床遭遇不适合患者的实际情况时，他们就不太可能对需要做什么达成共识。这反过来又会导致医生认为少数民族患者不顺从，忽视他们的建议。为了有效，这些基于医生的关于护理、行为和自我护理的讨论需要一种适应于文化假设、认知/情感问题和个体患者的系统性社会经济约束的对话。这一领域需要改进-治疗受健康差异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构建和定制对话的能力。我们设想的系统-通过辅助和培训实现增强的患者接触（重复）-将提供一个创新的替代目前（非常小）的培训。它将最佳实践封装在一个基于体验式学习的低成本、无处不在的系统中。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）的模拟互动进行学习。这些是交互式计算机生成的化身，可以在办公室中对临床医生的通信做出真实的行动和反应（通过语言和非语言） 访问新兴的认知模拟技术将为SSP注入属性（例如，环境和经济限制、信仰、态度、恐惧），这些特征代表特定患者亚群的共有特征。第一阶段建立了一个初步的REPEAT原型作为一个有限的虚拟临床接触，并使用毕业医学生的样本进行实验评估。评估显示，在REPEAT的主动辅导、反馈反馈和其他形式的辅导指导下，在REPEAT虚拟遭遇中进行几个小时的练习后，沟通表现（使用多种措施）有了显著改善。第二阶段将开发完整的课程，教授低收入非裔美国人患有T2 D或糖尿病前期肥胖所需的知识和技能，并有效地调整治疗计划以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REPEAT课程。该技术有可能被广泛使用，包括患者可用的版本，并通过改善提供者和患者之间的沟通来减少医疗差异。

 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.