How Organizations Shape Medical Device Use

新的医疗技术有可能支持更长和更健康的生活，但技术也可能加剧卫生不平等。这项研究探讨了不同的组织（例如，医疗诊所、科技公司、学校）影响糖尿病青年获得和使用医疗设备，以及这些关系如何形成健康不平等。该项目揭示了组织和政策制定者可以采取的步骤，以确保快速发展的医疗技术-以及参与其发展的大量公共和私人投资-更公平地支持更健康的人群。该项目关注糖尿病青年和可用于管理这种日益常见的疾病的技术，这个分两个阶段的项目询问专科医疗诊所，初级保健提供者（PCP），医疗技术公司和学校在获得和使用连续葡萄糖监测（CGM）设备和胰岛素泵方面形成了不平等。该项目的第一个完成阶段侧重于专科诊所，这些诊所在如何公平地开出设备方面存在差异，发现诊所如何理解技术及其与患者的匹配（有益，中性或风险）塑造了其分配和使用的不公平性。该项目的第二阶段增加了专业诊所以外的组织，包括PCP、科技公司和学校，以及跨组织的互动。这一阶段涉及跟踪和采访40名从专科诊所招募的人口统计学上相似的患者，以了解其他组织（科技公司，学校）和组织间的互动如何塑造医疗器械使用的公平性。项目结果将告知和评估一个组织为基础的干预，提供有关如何将公平研究转化为政策和实践的额外信息。该奖项反映了NSF的法定使命，并已被认为是值得通过使用基金会的知识价值和更广泛的影响审查标准进行评估的支持。

New medical technologies have the potential to support longer and healthier lives, but technologies can also exacerbate health inequities. This study examines how different organizations (e.g., medical clinics, tech companies, schools) influence access to and use of medical devices for youth with diabetes and how these relationships shape health inequities. The project sheds light on the steps that organizations and policymakers can take to ensure that rapidly-emerging healthcare technologies—and the substantial public and private investments involved in their development—more equitably support a healthier population.Focusing on youth with diabetes and the technologies available to manage this increasingly common illness, this two-phased project interrogates how specialty medical clinics, primary care providers (PCPs), medical technology companies, and schools shape inequities in access to and use of continuous glucose monitoring (CGM) devices and insulin pumps. The first completed phase of the project focused on specialty clinics that differed in how equitably they prescribed devices, finding that how clinics understand technologies and their match to patients (beneficial, neutral, or risky) shapes inequities in their allocation and use. The second phase of the project adds organizations outside of specialty clinics, including PCPs, tech companies, and schools, as well as interactions across organizations. This phase involves shadowing and interviewing 40 demographically-similar patients recruited from specialty clinics to understand how other organizations (tech companies, schools) and interactions across organizations shape equity in medical device use. Project findings will inform and evaluate an organizations-based intervention, providing additional information on how to transform equity research into policy and practice.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.