Effect of implicit racial bias on recommendation of patients for total knee repla

描述(由申请人提供)：种族和民族健康差距很大，在这些服务不足的社区，卫生保健质量下降。造成这些健康不平等的原因是复杂和多层面的。正如医学研究所所指出的那样，这些人口以及照顾他们的卫生系统中体现了历史和当代的社会不平等。此外，医疗保健提供者的种族偏见也可能在少数群体受到的不平等待遇中发挥作用。种族成见和偏见已被确定为提供心血管疾病护理、疼痛管理和精神卫生护理的因素。鉴于非洲裔美国人和患有严重骨关节炎的白人患者在接受全膝关节置换术方面有很好的记录差异，迫切需要进行研究，以更好地了解种族成见和偏见在提供这种治疗时造成这些不平等中所起的作用。在拟议的研究项目中，我们将客观地测量医生的种族刻板印象和偏见，并评估其与医生推荐患者进行TKR的相关性。我们还提出了一种创新的教育干预措施，旨在减少种族偏见对临床决策的影响，并将评估其有效性。这项探索性研究的结果将被用于开发一项更大、更长期的研究，研究临床决策中的种族刻板印象和偏见，以及减轻其影响的干预方法。特定目标1将使用基于网络的调查工具来测试医生是否表现出明显的种族偏见。特定目标2将使用基于网络的隐性联想测试(IATS)来测试医生是否表现出隐性种族偏见。具体目标3将评估内隐偏见的大小是否可以预测医生对患有严重骨关节炎的非裔美国人和白人患者的TKR的推荐。具体目标4将评估使用基于网络的IAT作为教育干预是否减少了隐性种族偏见对医生推荐TKR的影响。公共卫生相关性：拟议的研究项目测试了一种干预措施，以帮助医生管理甚至消除他们的种族偏见。如果这种干预被证明是有效的，我们将拥有一个强大的工具来帮助缩小种族健康差距。

DESCRIPTION (provided by applicant): Racial and ethnic health disparities abound, with decreased quality of health care in these underserved communities. The reasons for these health inequities are complex and multi-layered. As noted by the Institute of Medicine, there are historic and contemporary social inequities that have been embodied in these populations and in the health systems that care for them. In addition, racial biases of health care providers also may play a role in the unequal treatment of minority populations. Racial stereotyping and bias have been identified as factors in the delivery of cardiovascular disease care, pain management, and mental health care. Given the well-documented disparity in the receipt of total knee replacements between African-American and white patients with severe osteoarthritis, research is sorely needed to better understand what role racial stereotyping and bias plays in creating these inequities in the provision of this treatment. In the proposed research project, we will objectively measure physicians' racial stereotyping and bias and evaluate its association with those physicians' recommendations of patients for TKR. We also propose an innovative educational intervention aimed at reducing the effect of racial bias on clinical decision-making and will assess its efficacy. Findings from this exploratory study will be used to develop a larger, more long-term study of racial stereotyping and bias in clinical decision-making and methods for intervening to mitigate their effects. Specific Aim 1 will test whether physicians express explicit racial bias, using a Web-based survey instrument. Specific Aim 2 will test whether physicians show implicit racial bias, using Web-based Implicit Association Tests (IATs). Specific Aim 3 will evaluate whether the magnitude of implicit bias predicts physician recommendation of TKR for African-American and white patients with severe osteoarthritis. Specific Aim 4 will assess whether use of the Web-based IAT as an educational intervention decreases the effect of implicit racial bias on physician recommendation of TKR. Public Health Relevance: The proposed research project tests an intervention to help physicians manage and, perhaps, eliminate their racial bias. If this intervention proves effective, we will have a powerful tool to help reduce racial health disparities.