Developing a Sociotechnical Systems Analysis Approach for Investigating Systems Inequities

开发社会技术系统分析方法来调查系统不平等

• 批准号: RGPIN-2022-04878
• 负责人: Alfred, Myrtede
• 金额: $ 1.97万
• 依托单位: University of Toronto
• 依托单位国家: 加拿大
• 项目类别: Discovery Grants Program - Individual
• 财政年份: 2022
• 资助国家: 加拿大
• 起止时间: 2022-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://www.nserc-crsng.gc.ca/ase-oro/Details-Detailles_eng.asp?id=759618
• 关键词: Developing; Sociotechnical; Systems; Analysis; Approach

While structural inequities exist in a broad range of systems, there is emerging evidence that health systems are plagued by systemic biases. Prior research has identified over 175 studies documenting racial/ethnic disparities in healthcare. Inequities designed into the system through biased algorithms, poor process design, continued use of racist medical practices, medical devices unreliable for people of colour, and implicit bias and culturally insensitive care. Characterizing systems biases are extremely difficult due to a lack of a well-defined conceptual model, challenges in the availability and quality of data (including insensitive measures), and ill-defined data analysis approaches. Industrial and systems engineering (ISE) approaches have been utilized to improve system design in many domains and would be exceptionally well-suited for identifying underlying systemic issues contributing to disparate outcomes. ISE provides a strong theoretical basis for examining systems equity, having long documented systemic deficiencies that can result when the design processes fail to account for key groups of users, including marginalized communities ignored or denied representation in the design of the health systems. This research is innovative in combining ISE-with its traditional emphasis on safety-and leveraging intersectionality for understanding disproportionate risks on marginalized communities. One specific healthcare context where equity challenges are particularly salient is maternal health. Maternal mortality and severe maternal morbidity (SSM) have increased in Canada in the past 20 years. Racial and ethnic disparities are prevalent across all causes of maternal mortality and SSM. In the US, Maternal mortality and SMM are also associated with billions of dollars in healthcare expenditures. Half of all maternal deaths and SMM are preventable through timely and risk-appropriate care. The presence of substantial and persistent disparities after controlling for patient and hospital factors suggest systemic inequities in the design of the maternal care systems. Utilizing maternal care as a paradigm, this work will investigates inequity in health systems using ISE. The work seeks to develop a well-defined ISE methodology that can applied to identify system inequities, identify causal factors contributing to these inequities, and monitor variations as part of ongoing system safety efforts. As the Canadian population continues to diversify, understanding how health systems do or do not work for the populations they serve is essential for redesigning clinical pathways to provide safe, equitable care, and cost-effective care. Focusing on clinical system contributors to disparities is a novel underlying thread of this research aligning conceptually with population health and healthcare engineering frameworks and offering profound implication that extend far-beyond maternal health disparities for any health system.

虽然结构性不平等存在于广泛的系统中，但有新的证据表明，卫生系统受到系统性偏见的困扰。此前的研究已经确定了超过175项记录医疗保健中种族/民族差异的研究。通过有偏见的算法、糟糕的流程设计、继续使用种族主义医疗做法、对有色人种不可靠的医疗设备以及隐含的偏见和对文化不敏感的护理，系统中存在不公平现象。由于缺乏定义明确的概念模型，数据的可用性和质量（包括不敏感的措施）以及定义不清的数据分析方法，表征系统偏差非常困难。工业和系统工程（ISE）方法已被用于改善许多领域的系统设计，并将非常适合于识别导致不同结果的潜在系统性问题。 系统公平性为审查系统公平性提供了强有力的理论基础，长期以来有文件证明系统缺陷，当设计过程未能考虑到关键用户群体，包括在卫生系统设计中被忽视或被剥夺代表权的边缘化社区时，可能会导致这种缺陷。这项研究是创新性的，它结合了ISE与传统的安全重点，并利用交叉性来了解边缘化社区的不成比例的风险。公平性挑战特别突出的一个具体保健领域是孕产妇保健。在过去20年中，加拿大的孕产妇死亡率和严重孕产妇发病率有所上升。种族和族裔差异普遍存在于孕产妇死亡和特殊保健的所有原因中。在美国，孕产妇死亡率和SMM也与数十亿美元的医疗保健支出有关。通过及时和风险适当的护理，一半的孕产妇死亡和SMM是可以预防的。在控制了患者和医院因素后，存在着大量和持续的差异，这表明在孕产妇保健系统的设计中存在着系统性的不公平。这项工作将利用孕产妇保健作为范例，调查卫生系统中的不平等问题。这项工作旨在开发一种定义明确的ISE方法，可用于识别系统不公平性，确定导致这些不公平性的因果因素，并监测变化，作为正在进行的系统安全工作的一部分。 随着加拿大人口的不断多样化，了解卫生系统如何为他们所服务的人群工作，对于重新设计临床路径以提供安全，公平的护理和具有成本效益的护理至关重要。关注临床系统差异的贡献者是本研究的一个新的基本线索，在概念上与人口健康和医疗保健工程框架相一致，并提供了远远超出任何卫生系统孕产妇健康差异的深刻影响。