Compassion Disparities in Primary Care: A Mixed Methods Pilot Study

项目摘要/摘要 背景：医疗保健差异是指与患者种族有关的医疗质量方面的显著差异， 种族、社会经济地位或其他因素。医疗质量的一个至关重要的因素是 缺乏关于差异的数据：治疗临床医生的同情心。同情心受到患者的高度重视， 对于高质量的医疗保健是必不可少的。例如，缺乏临床医生的同情心可能会导致患者 对医疗保健系统的不信任，这与患者不坚持健康维护和 治疗建议。了解同情心差异对于改善医疗公平至关重要。 由于隐性偏见和/或种族主义，健康差距人群从临床医生那里得到的同情可能会更少。 然而，我们先前的研究表明，传统的术后患者体验(满意度)调查 容易出现无反应偏见，因此不足以测试同情心的差异。匿名的，真实的- 时间、护理点评估是必要的。对于医疗保健公平而言，这是一个至关重要的知识鸿沟。 与无差异人群相比，我们假设(1)健康差异人群中的患者 临床医生的同情心较少，(2)对健康差距人群的同情心较少起到中介作用 医疗系统不信任，以及(3)突出的临床医生行为传达同情(或缺乏)来自 对于健康差距人群，患者的观点有所不同。目标：在不同的初选人群中 护理患者，(1)我们将测试患者对临床医生同情心体验的差异 没有低SES的患者和(A)黑人或非裔美国人，(B)西班牙裔或拉丁裔，或(C)低SES患者。 (2)我们将测试患者对临床医生同情心的体验是否会调节医疗系统不信任的差异 在上面的种群之间。(3)从患者的角度，我们将找出突出临床医生的差异 在上面的人群之间传达同情(或缺乏)的行为。方法/环境：在 由26个不同的学术初级保健诊所组成的网络，我们将进行横断面混合方法队列 收集患者对临床医生同情心的匿名、实时、护理点评估的研究 视角(n=350)。我们将使用5项同情心测量，这是一个半定量的研究工具，我们 在之前的三项研究中得到了验证，包括实时评估。我们将测试人群中的差异 以上根据患者、系统和临床医生层面的因素进行了调整。我们还将使用经过验证的医疗保健 系统不信任量表，以测试临床医生的同情心是否中介(即，是否处于患者的因果路径上) 对上面的人群不信任医疗保健系统。我们将使用开放式问题(即定性问题 方法)确定临床医生传达(或削弱)同情心的行为的显著差异 从患者的角度来看，上面的人群。这些数据将通知未来的R01应用程序 为临床医生开发和测试了解患者情况的培训课程，以提高对健康差距的同情心 通过消除同情心差异，减少患者对医疗保健系统的不信任。

Project Summary/Abstract Background: Healthcare disparities are meaningful differences in healthcare quality linked to patient race, ethnicity, socioeconomic status (SES), or other factors. There is a vital element of healthcare quality with a paucity of data on disparities: compassion from treating clinicians. Compassion is highly valued by patients and essential for high quality healthcare. For example, a lack of clinician compassion could contribute to patient distrust of the healthcare system, which is associated with patient non-adherence to health maintenance and treatment recommendations. Understanding compassion disparities is vital for improving healthcare equity. Health disparity populations may receive less compassion from clinicians due to implicit bias and/or racism. However, our prior research has shown that conventional after-care patient experience (satisfaction) surveys are prone to nonresponse bias and thus are inadequate to test for compassion disparities. Anonymous, real- time, point-of-care assessments are needed. This is a critically important knowledge gap for healthcare equity. Compared to nondisparity populations, we hypothesize that (1) patients in health disparity populations experience less compassion from clinicians, (2) less compassion for health disparity populations mediates healthcare system distrust, and (3) salient clinician behaviors that communicate compassion (or lack of) from the patient perspective differ for health disparity populations. Objectives: In a diverse population of primary care patients, (1) we will test for differences in patient experience of clinician compassion between White patients without low SES and (a) Black or African American, (b) Hispanic or Latinx, or (c) low SES patients. (2) We will test if patient experience of clinician compassion mediates differences in healthcare system distrust between the populations above. (3) From the patient perspective, we will identify differences in salient clinician behaviors that communicate compassion (or lack of) between the populations above. Methods/environment: In a network of 26 diverse academic primary care clinics, we will perform a cross-sectional mixed methods cohort study collecting anonymous, real-time, point-of-care assessments of clinician compassion from the patient perspective (n=350). We will use the 5-Item Compassion Measure, a semi-quantitative research tool that we validated in three prior studies including real-time evaluation. We will test for differences in the populations above adjusted for patient, system, and clinician-level factors. We will also use the validated Healthcare System Distrust Scale to test if clinician compassion mediates (i.e., is on the causal pathway for) patient distrust of the healthcare system for the populations above. We will use open-ended questions (i.e., qualitative methods) to identify salient differences in clinician behaviors that communicate (or detract from) compassion from the patient perspective for the populations above. These data will inform a future R01 application to develop and test patient-informed training curricula for clinicians to raise compassion for health disparity populations and reduce patient distrust of the healthcare system through elimination of compassion disparities.