PAINED: Project Addressing INequities in the Emergency Department

项目摘要 种族和民族在医疗质量方面的不平等已经在广泛的临床上得到了描述 环境、患者群体和结果。临床医生的内隐偏见已被牵连在因果关系中 医疗保健方面的差距。现在当务之急是，我们必须针对原因并制定干预措施，以减轻 并消除这种不平等现象。我们的首要目标是通过证据消除医疗保健不平等- 以干预为基础。回应RFA-NS-22-002：治愈倡议：促进疼痛中的健康公平 管理(R61/R33)，本提案的目标是制定和测试两个 关于克服临床医生内隐偏见和减轻疼痛管理中的不平等的干预措施 在急诊科寻求治疗阑尾炎或长骨骨折的儿童。 科学前提源于我们先前的工作，即：1)在 急诊科儿童疼痛的管理；2)研究了内隐偏见在环境中的作用。 基于健康结果；以及3)使用审计和反馈以及临床决策支持工具来改进 临床医生的绩效指标。我们将在这项基础性工作的基础上，衡量 临床医生在过程和结果测量上的提供者和护士之间的内隐偏见，包括 评估和减轻疼痛。我们将使用利益相关者知情的方法来确定以下质量指标 是以病人为中心的。然后，我们将测试定期临床医生审计和反馈是否通过提供 “股权成绩单”，以及提供嵌入电子健康记录的实时临床决策 支持可以作为有用的干预措施，缓解临床结果中的种族/民族差异。这 研究意义重大，因为这两种干预措施都可以廉价传播，并可扩展到紧急情况 国家科室以及其他临床场所，并根据不同的临床情况进行调整。穿过 创新的研究设计和严格的评估，这项建议将提供关键的证据和奠定 在提供护理和改善儿童健康方面消除种族和族裔不平等的基金会 成果惠及所有人。

Project Abstract Racial and ethnic inequities in health care quality have been described across a broad range of clinical settings, patient populations, and outcomes. Clinician implicit bias has been implicated in the causal pathway for health care disparities. It is now imperative that we target the causes and develop interventions to mitigate and eradicate such inequities. Our overarching goal is to eradicate health care inequities through evidence- based interventions. In response to the RFA-NS-22-002: HEAL Initiative: Advancing Health Equity in Pain Management (R61/R33), the objectives of this proposal are to develop and test the impact of two interventions on overcoming clinician implicit bias and mitigating inequities in the management of pain among children seeking care in the emergency department for the treatment of appendicitis or long bone fractures. The scientific premise stems from our prior work which: 1) demonstrated racial and ethnic inequities in the management of pain for children in the emergency department; 2) examined the role of implicit bias in vignette- based health outcomes; and 3) used audit and feedback and clinical decision support tools to improve performance metrics among clinicians. We will build on this foundational work by measuring the impact of clinician implicit bias among providers and nurses on both process and outcome measures, including the assessment and reduction of pain. We will use a stakeholder-informed approach to identify quality metrics that are patient-centric. We will then test whether regular clinician audit and feedback, through the provision of ‘Equity Report Cards,’ as well as provision of real-time, electronic health record-embedded clinical decision support can serve as useful interventions in mitigating racial/ethnic disparities in clinical outcomes. This research is significant because both interventions can be inexpensively disseminated and scaled to emergency departments nationally as well as to other clinical venues and adapted for various clinical conditions. Through innovative study design and rigorous evaluation, this proposal will provide critical evidence and lay the foundation for eradicating racial and ethnic inequities in the provision of care and improved child health outcomes for all.