Gender Disparities in Invasive CVD Procedure Use: the Role of Provider Bias

描述(由申请人提供)：项目摘要/摘要我的长期职业目标是成为全国公认的心血管疾病(CVD)差距的独立调查者和专家，重点是旨在消除差距的干预措施。我定义了一个广泛的指导网络，接受了卫生服务研究方面的正式培训，并领导了几个研究项目，为实现这一目标奠定了坚实的基础。到目前为止，我的研究主要集中在描述心血管疾病护理中的性别差异。例如，我已经证明，患有心血管疾病的女性接受的侵入性手术比患有心血管疾病的男性要少。尽管有大量研究记录了这些差异，但很少有人调查其原因。我致力于解决这一差距，通过开展研究，旨在了解性别差距背后的机制，以实现我的最终目标，即建立以证据为基础的干预措施，以减少心血管疾病护理中的性别差距。医学研究所发现，医疗服务提供者的偏见是造成医疗保健不平等的关键因素。然而，提供者偏见在围绕使用侵入性CVD程序的基于性别的决策中的作用并不是很有特点。为了更准确和全面地衡量提供者的态度，必须使用先进的定性和社会心理学技术；我希望发展这些技能。因此，我寻求职业发展奖，让我有时间和支持进行指导研究，旨在衡量提供者的性别态度和在定性研究、社会心理学和高级生物统计技术领域的培训。拟议的研究和培训对于推动我的研究从界定性别差距转向旨在了解这些差距的原因的研究至关重要。尽管研究表明提供者的偏见是心血管疾病护理中性别差异的原因，但据我们所知，还没有研究使用有效的工具直接衡量这种态度。在其他领域已经开发了测量内隐(无意识)性别态度的工具，如内隐联想测试(IAT)。这些工具已被广泛用于解释社会结果中的性别差异，包括工作晋升和绩效评估，但它们尚未被广泛应用于医疗保健差异的研究。此外，可能需要对这些工具进行调整，以获取特定于心血管疾病护理的概念，例如提供者对妇女是否愿意接受侵入性手术的信念，或者提供者是否认为妇女很脆弱，因此更有可能因侵入性手术而出现并发症。这一知识差距是制定以证据为基础的干预措施以解决性别差距的障碍。这一职业发展奖的研究目标是调整现有的性别态度衡量标准，使之适用于有关使用侵入性心血管疾病程序的决定，并对这些调整后的措施进行初步测试。这项研究将分三步进行。对于目标1，我将对心脏病专家进行半结构化访谈，使用两种可能推荐侵入性心脏手术的案例情景。这些访谈将被用来确定提供者对侵入性心脏手术的性别态度，然后结果将被用来调整现有的性别态度测量。接下来，在目标2中，我将在第二批心脏病专家中测试适应的措施，以确定在标准情况下，测量的态度与提供者决定对女性和男性使用侵入性心脏手术之间的关系。最后，在目标3中，我将进行一项研究，以测试我将调整后的测量结果与受试者心脏病专家从回顾临床数据中获得的实际临床决定联系起来的能力。作为一名卫生服务研究员、女性和执业心脏病专家，我处于独特的地位，能够在性别差异和心血管疾病领域做出重要贡献。我将在社会心理学和卫生服务研究领域架起桥梁，以便更好地了解造成性别差距的潜在因素，并规划旨在减少或消除心血管疾病护理方面差距的多式联运干预措施。我广泛的方法培训、研究经验和拟议的培训活动使我处于执行拟议研究的理想位置。此外，科罗拉多大学丹佛分校及其附属校区的独特资源将确保我成功实现这些目标。具体地说，我的指导团队包括以下领域的专家：卫生服务和差异研究(Masoudi、Havranek和Blair博士)、使用社会心理学实验程序测量外显和内隐偏见(Blair博士)、基于定性技术的调查工具的调整(Dr.Main)和高级分层模型(Dr.Dickinson)。这群合格的导师和我提议的培训活动将确保我成功地过渡到独立。 公共卫生相关性：项目描述我们知道，女性比男性更不可能接受某些心脏病手术。这项研究项目的目的是了解卫生保健提供者对女性和男性所具有的特征的信念或刻板印象是否可能解释这些差异。

DESCRIPTION (provided by applicant): PROJECT SUMMARY/ABSTRACT My long-term career goal is to become a nationally recognized independent investigator and expert in cardiovascular disease (CVD) disparities with an emphasis on interventions designed to eliminate disparities. I have laid a strong foundation for reaching this goal by defining a broad mentoring network, obtaining formal training in health services research, and leading several research projects. To date, my research has primarily focused on describing gender disparities in CVD care. For example, I have shown that women with CVD receive fewer invasive procedures than men with CVD. Despite extensive research documenting these disparities, few have investigated their causes. I am committing my career to addressing this gap by conducting research aimed at understanding the mechanisms behind gender disparities to achieve my ultimate goal of instituting evidence-based interventions to reduce gender disparities in CVD care. The Institute of Medicine has identified provider bias as a key contributor to disparities in health care. However, the role of provider bias in gender-based decisions surrounding the use of invasive CVD procedures is poorly characterized. In order to more accurately and fully measure provider attitudes, advanced qualitative and social psychology techniques must be employed; skills I wish to develop. Therefore, I seek a Career Development Award to allow me time and support to pursue mentored research aimed at measuring provider gender attitudes and training in the areas of qualitative research, social psychology and advanced biostatistical techniques. The proposed research and training are a crucial to move my research forward from defining gender disparities towards research aimed at understanding the causes of these disparities. Although studies have implicated provider bias as the cause of gender disparities in CVD care, to our knowledge, no study has directly measured such attitudes using validated instruments. Tools have been developed in other fields that measure implicit (unconscious) gender attitudes such as the Implicit Association Test (IAT). These tools have been widely used to explain gender differences in social outcomes including job promotions and performance evaluations, but they have not been widely applied to the study of health care disparities. Furthermore, these tools may need to be adapted to capture concepts specific to CVD care, such as a provider's belief about women's willingness to undergo invasive procedures or whether a provider views women as fragile and therefore more likely to have a complication from an invasive procedure. This gap in knowledge is a barrier to developing evidence-based interventions to address gender disparities. The research objectives of this Career Development Award are to adapt existing measures of gender attitudes to apply to decisions concerning the use of invasive CVD procedures and to conduct preliminary tests of these adapted measures. The research will occur in three steps. For aim 1, I will conduct semi-structured interviews with cardiologists, using two case scenarios in which an invasive cardiac procedure might be recommended. These interviews will be used to determine providers' gender attitudes specific to invasive cardiac procedures, and the results will then be used to adapt existing measures of gender attitudes. Next, in aim 2, I will test the adapted measures within a second cohort of cardiologists to determine the relationship between measured attitudes and the providers' decision to use an invasive cardiac procedure with women and men in the standard case scenarios. Finally, in aim 3, I will conduct a study to test my ability to link the adapted measures results and the subject cardiologists' actual clinical decisions obtained from retrospective clinical data. As a health services researcher, woman and practicing cardiologist, I am uniquely positioned to make important contributions to the field of gender disparities and CVD. I will bridge the fields of social psychology and health services research in order to gain a better understanding of potential contributors to gender disparities and plan for multimodal interventions aimed at reducing or eliminating disparities in CVD care. My extensive methodological training, research experience and proposed training activities make me ideally positioned to perform the proposed studies. Furthermore, the unique resources available at the University of Colorado Denver and its affiliated campuses will ensure my success towards these goals. Specifically, my mentorship team includes experts in health services and disparities research (Drs. Masoudi, Havranek, and Blair), measurement of explicit and implicit bias using social psychology experimental procedures (Dr. Blair), adaption of survey tools based on qualitative techniques (Dr. Main) and advanced hierarchical modeling (Dr. Dickinson). This qualified group of mentors and the training activities I propose will ensure my successful transition towards independence. PUBLIC HEALTH RELEVANCE: Project Narrative We know that women are less likely than men to get certain cardiology procedures. The purpose of this research project is to understand if health care providers' beliefs, or stereotypes, about the traits that women and men have potentially explain these differences.