Perceived Bias in Medical Care among Ethnically Diverse Adults with Diabetes

描述（由申请人提供）：该项目的目标是制定患者报告的与卫生保健专业人员接触时感知偏见的测量方法，检查这些测量方法的心理测量特性，并探索偏见和歧视的感知对医生和病人之间关系的影响，包括对卫生保健的信任和满意度。该项目将评估目前的感知偏见措施，并提出可用于引出患者对医疗中种族或种族偏见的看法的问题。改进后的问题将针对医疗保健，适用于任何健康状况，并适用于任何种族群体，以衡量患者对偏见的看法。通过对非裔美国人、拉美裔和非西班牙裔白人的一系列焦点小组访谈和两轮认知访谈，我们将评估患者的偏见经历，检查他们对调查问题的理解，探索他们如何回应有关偏见的问题，并在必要时开发和修改问题。我们将在CAHPS门诊护理调查的基础上进行一项调查的试点测试，该调查包括一个关于医疗偏见问题的补充模块。试点测试将在两个联邦资助的保健中心进行，这些中心为不同种族的人口提供服务。我们将评估偏倚问题的心理测量特性，包括信度、内容效度和构念效度。采用一个概念模型，将感知到的偏见嵌入到医患关系的干预影响中，我们将检验这样一个假设，即报告偏见经历的患者对医疗保健专业人员的信任度较低，随后对医疗建议的依从性较低，对疾病的自我管理较差。本项目开发的调查工具可用于改善患者与卫生保健专业人员之间的沟通。一个简短的调查问题模块引出患者对医疗保健偏倚的报告，将用于评估感知偏倚、对卫生专业人员的信任、参与性决策和对糖尿病推荐治疗的依从性之间的关系。这些衡量医疗保健偏差的新工具可用于监测干预措施对患者和卫生专业人员进行培训和教育后患者观念的变化。在美国，健康差异是一个严重的公共卫生问题。与非西班牙裔白人相比，非裔美国人和拉丁裔美国人与糖尿病相关的死亡率一直较高。患者对偏见的感知可能是发展患者与卫生专业人员之间有效关系的障碍。这个项目将创造新的方法来收集关于医疗护理中患者偏见报告的信息。

DESCRIPTION (provided by applicant): The goals of this project are to develop patient-reported measures of perceived bias in their encounters with health care professionals, to examine the psychometric properties of these measures, and to explore the effect of perceptions of bias and discrimination on relations between doctors and patients, including trust and satisfaction with health care. This project will assess current measures of perceived bias and develop questions that can be used to elicit patient perceptions of ethnic or racial bias in medical care. The improved questions to measure patient perceptions of bias will be specific to medical care, applicable to any health condition, and appropriate for any ethnic group. Using a series of focused group interviews and two rounds of cognitive interviews with African Americans, Latinos, and non-Hispanic whites, we will assess patients' experiences with bias, examine their understanding of survey questions, explore how they respond to questions about bias, and develop and revise questions, as necessary. We will field a pilot test of a survey based on the CAHPS Ambulatory Care survey that includes a supplemental module of questions about bias in medical care. The pilot test will be conducted in two federally-funded health centers that serve ethnically diverse populations. We will assess the psychometric properties of questions about bias, including reliability, content validity, and construct validity. Employing a conceptual model that embeds perceived bias as an intervening influence on the patient-physician relationship, we will test the hypothesis that patients reporting experiences of bias have less trust in health care professionals and subsequently less adherence to medical advice and poorer self management of disease. Survey tools developed in this project may be used to improve communication between patients and health care professionals. A short module of survey questions to elicit patient reports of bias in medical care will be used to assess the association among perceived bias, trust in health professionals, participatory decision making, and adherence to recommended treatment of diabetes. These new tools to measure bias in medical care can be used to monitor change's in patient perceptions after interventions to train and educate both patients and health professionals. Disparities in health are a severe public health problem in the United States. Compared with non-Hispanic whites, diabetes-related death rates are consistently higher for African American and Latinos. Patients' perception of bias is a likely barrier to developing effective relations between patients and health professionals. This project will create new methods to collect information about patient reports of bias in medical care.