Race/Ethnic Disparities in Diabetes: An Experiment

描述（由申请人提供）：关于“糖尿病并发症发生率的种族/民族差异”的项目公告（PA-02-165）邀请对“生物和非生物因素”进行研究，并表明种族/民族和社会经济地位的差异可能部分归因于提供者行为和医疗保健系统的影响。这项基于理论的研究建立在早期研究的经验和成功的基础上，并调查了提供者行为和卫生保健系统特征（两者都可能是可修改的）对2型糖尿病临床管理中观察到的差异的贡献。新颖的使用实验（析因）设计产生无混淆的估计不同类型的患者，供应商和卫生系统的贡献，公认的差距。 该项目有四个目标：1）估计患者属性的影响（人种/种族、性别、年龄和SES）对两种常见临床情况的临床决策（CDM）的影响（未诊断的糖尿病症状和体征以及已诊断的糖尿病并发症）; 2）估计医师特征的影响（年龄/临床经验和性别）提交病例的CDM; 3）衡量卫生保健系统的特点对CDM的影响-无论是在美国（实践环境、所有权和资金安排）和不同系统之间的差异（为了比较的目的，需要包括其他系统）; 4）了解所观察到的清洁发展机制差异的基本认知原因。 本研究将健康差异研究的重点从个体（患者）的行为、生物生理学和遗传背景转移到提供者决策和卫生系统影响方面。深刻的政策含义遵循的建议，消除健康差距应寻求尽可能多的通过改变供应商的行为和系统，通过那些有风险的糖尿病及其并发症的生物生理学和保健行为。

DESCRIPTION (provided by applicant): Program Announcement (PA-02-165) concerning "Race/Ethnic Disparities in the Incidence of Diabetes Complications" invited research on "both biologic and non-biologic factors" and suggested that differences by race/ethnicity and socioeconomic status may be partly due to provider behavior and health care system influences. This theoretically based research builds on the experience and success of earlier studies and investigates the contribution of provider behavior and features of the health care system (both potentially modifiable) to observed disparities in the clinical management of type 2 diabetes mellitus. Novel use of an experimental (factorial) design yields unconfounded estimates of different types of patient, provider and health system contributions to recognized disparities. The project has four aims: 1) to estimate the influence of patient attributes (race/ethnicity, gender, age and SES) on clinical decision making (CDM) for two commonly presented clinical situations (undiagnosed symptoms and signs of diabetes and already diagnosed diabetes with complications); 2) to estimate the influence of physician characteristics (age/clinical experience and gender) on CDM for the presenting cases; 3) to measure the influence of features of the health care system on CDM - both within the US (practice setting, ownership and financial arrangement) and between different systems (requiring the inclusion of other systems for purposes of comparison); 4) to understand the underlying cognitive reasons for the differences in CDM that are observed. This research moves the focus of health disparities research from the behavior, biophysiology and genetic background of individuals (patients) to aspects of provider decision-making and health system influences. Profound policy implications follow from the suggestion that the elimination of health disparities should be sought as much through changes in provider behavior and the system, as through the biophysiology and health care behaviors of those at risk to diabetes and its complications.