Using multimedia patient feedback to reduce disparities in VA healthcare

拟议中的研究将为退伍军人的两个严重问题提供重要的见解。 医疗保健：1）VA中沟通改善干预措施的效果好坏参半， 日期，以及2）VA医疗保健中种族/民族差异的持续性。我们已经确定了4个“最佳 患者认为在临床治疗中最重要的医生沟通行为 互动我们建议开发和评估一种医生沟通干预， 特别关注这些行为。此外，我们从患者中获得的大量初步研究数据， 不同种族/民族使我们能够创建适用于通信的干预， 跨越患者种族/民族。与医生和患者一起评估这种干预措施， 独立的VA初级保健设置将有助于确定患者驱动的 将不同种族/民族患者的意见纳入沟通重点有助于 “缩小白色和少数族裔退伍军人之间健康结果的差距”。 我们的目标是（1）证明使用医生沟通的“最佳行为”的有效性， 干预内容，以提高医生的整体沟通技能， 与白色患者相比，与种族/少数民族患者沟通的差异，以及（2）评估 患者体验“最佳行为”对患者感知和行为结果的影响。 我们收集了200多名初级保健患者的数据，他们观看了一段视频， 他们自己和他们的医生在诊所就诊期间进行互动。根据这些数据，我们 为医生制定教育干预措施，特别关注4个“最佳 “我们发现的行为。4场“最佳表演”的剧本将被开发并标准化 贝勒医学院的病人将表演这些行为，这些行为将被录像。我们 然后将对16名初级保健医生（8名在 每个站点）和每个医生的36名患者。在第一个研究中心，每隔3个月，医生将 参加一个指导会议，包括观看一个最佳行为的视频，并参与 小组讨论、角色扮演重演该法案以及制定项目符号“要点” 以方便以后的回忆。一旦完成，会议的顺序将在 第二个网站。在这两个研究中心，参与医生和患者的临床互动将 音频记录，并将分析音频记录中4“最佳 行为的“每次研究访问后，每位患者将完成有效的调查， 他们的医生对4个情感维度的看法，已知会影响患者的后续 感知和行为结果。将在患者人口统计学中评估疗效。

The proposed research will provide important insight into two serious problems for veterans' healthcare: 1) mixed effectiveness of communication improvement interventions in the VA to date, and 2) persistence of racial/ethnic disparities in VA healthcare. We have identified 4 "best acts" of physician communication that patients believe to be most important in a clinical interaction. We propose to develop and evaluate a physician communication intervention that focuses specifically on these acts. In addition, our abundance of pilot study data from patients of various races/ethnicities enables us to create an intervention applicable to communication that spans patient race/ethnicity. Evaluating this intervention with physicians and patients in 2 independent VA primary care settings will help determine whether a patient-driven communication focus that incorporates input from patients of varied race/ethnicity can help "close the gap" in health outcomes between white and minority veterans. We aim to (1) demonstrate the efficacy of using "best acts" of physician communication as content for an intervention to improve physician communication skills overall and reduce variation in communication with white versus racial/ethnic minority patients, and (2) assess the impact of patient experiences of "best acts" on patients' perceptual and behavioral outcomes. We have collected data from over 200 primary care patients as they viewed a video of themselves and their physician interacting during a clinic visit. From these data, we are developing an educational intervention for physicians that focuses specifically on the 4 "best acts" we have identified. Scripts of the 4 "best acts" will be developed, and standardized patients at Baylor College of Medicine will perform the acts, which will be video recorded. We will then conduct a 2-site longitudinal observational study of 16 primary care physicians (8 at each site) and 36 patients of each physician. At the first site at 3-month intervals, physicians will attend an instruction session consisting of viewing a video of one best act and participating in group discussion, role-playing re-enactment of the act, and formulation of bulleted "take-away" points to facilitate subsequent recall. Once completed, the sequence of sessions will occur at the second site. At both sites, clinical interactions of participating physicians and patients will be audio recorded, and audio recordings will be analyzed for frequency of occurrence of the 4 "best acts." After each study visit, each patient will complete validated surveys measuring patients' perceptions of their physician on 4 affective dimensions known to impact patients' subsequent perceptual and behavioral outcomes. Efficacy will be assessed across patient demographics.