Race/Ethnic Disparities in Diabetes: An Experiment

描述(由申请人提供)：关于“糖尿病并发症发病率中的种族/民族差异”的项目公告(PA-02-165)邀请了对“生物和非生物因素”的研究，并提出种族/民族和社会经济地位的差异可能部分是由于提供者的行为和卫生保健系统的影响。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，并调查了提供者的行为和医疗保健系统的特征(两者都可能是可修改的)对观察到的2型糖尿病临床管理中的差异的贡献。实验(析因)设计的新应用产生了对不同类型的患者、提供者和卫生系统对公认差异的贡献的明确估计。 该项目有四个目标：1)评估患者属性(种族/民族、性别、年龄和社会经济地位)对两种常见临床情况(未诊断的糖尿病症状和体征以及已诊断的糖尿病合并并发症)的临床决策(CDM)的影响；2)评估医生特征(年龄/临床经验和性别)对提交病例的CDM的影响；3)衡量卫生保健系统的特征对CDM的影响--既包括美国境内的(执业环境、所有权和财务安排)，也包括不同系统之间的影响(为了进行比较，需要纳入其他系统)；4)了解所观察到的清洁发展机制差异的潜在认知原因。 这项研究将健康差异研究的重点从个人(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。有人建议，应该通过改变提供者的行为和系统，以及通过糖尿病及其并发症风险人群的生物生理学和保健行为来寻求消除健康差距，这一建议带来了深刻的政策影响。

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.