Measuring Cultural Competence and Racial Bias Among Physicians

描述（由申请人提供）：新出现的证据表明，医患关系中的种族障碍可能是医疗保健质量差异的重要来源。这些障碍包括医生和患者之间的文化差异;与其他种族或族裔群体的人交往时的社会不适或不信任（“种族间焦虑”）;以及医生对少数民族患者的负面种族偏见或陈规定型观念。“文化能力”培训已成为减少病人和医生之间种族障碍影响的主要手段。然而，迄今为止，只有有限的经验证据来告知文化能力培训的内容。具体来说，一直缺乏研究的性质和影响，具体的种族障碍的医患关系，以及知识，态度和技能，以减少他们。这项发展补助金申请的目的是开发和测试必要的工具，以衡量种族障碍和文化能力的病人-医生的关系，作为第一步，以评估他们的作用，造成和减轻，分别在医疗保健质量和结果的种族差异。我们的具体目标是：1）开发一个心理测量的声音仪器测量医生之间的文化能力; 2）测试量表测量医生之间的跨种族焦虑的可靠性和有效性;和3）测试一个计算机化的，交互式的工具测量医生之间的种族偏见的有效性。我们将使用多步骤的方法来实现这些目标，包括专家对调查项目草案的科学审查，与执业医生的认知访谈，全国医生调查和心理测量分析。发展和测试措施的文化能力和种族障碍的病人-医生的关系，将提供必要的工具，以推进种族差异的研究在医疗保健。这些措施将至少起到三个关键作用。首先，它们将使我们能够经验性地评估医生偏见的作用，以及医患关系中的其他种族障碍，以解释医疗保健质量的差异。其次，它们将使我们能够确定文化能力这一广泛概念的哪些方面（如果有的话）减少了种族障碍，从而减少了医疗保健的差距。这两个步骤将有助于为文化能力培训和其他干预措施的内容提供信息，以减少差异。最后，严格制定的种族障碍和文化能力的措施将提供必要的评估工具，判断文化能力计划的有效性，其中许多是目前正在开发的NIH赞助下。该项目的目的是开发和测试所需的工具，以探讨种族障碍在医患关系中作为医疗保健质量差距的根源所起的作用，以及医生之间的文化能力作为减轻这些障碍的手段所起的作用。需要这些工具来告知和评估未来的干预措施，以减少普遍存在的种族差异，在医疗保健质量和结果。

DESCRIPTION (provided by applicant): Emerging evidence suggests that racial barriers in the patient-physician relationship may be an important source of disparities in the quality of health care. These barriers include cultural dissimilarity between doctors and patients; social discomfort or distrust when interacting with people from other racial or ethnic groups ("interracial anxiety"); and negative racial bias or stereotyping of minority patients by physicians. Training in "cultural competence" has become the primary vehicle for reducing the impact of racial barriers betweens patients and physicians. To date, however, there has been limited empirical evidence to inform the content of cultural competence training. Specifically, there has been scant research on the nature and influence of specific racial barriers in the patient-physician relationship, and on the knowledge, attitudes, and skills needed to reduce them. The objective of this developmental grant application is to develop and test tools necessary to measure racial barriers and cultural competence in the patient-physician relationship, as a first step towards assessing their role in causing and mitigating, respectively, racial disparities in health care quality and outcomes. Our specific aims are to: 1) develop a psychometrically sound instrument measuring cultural competence among physicians; 2) test the reliability and validity of scales measuring interracial anxiety among physicians; and 3) test the validity of a computerized, interactive tool measuring racial bias among physicians. We will use a multi-step approach to achieve these aims, including expert scientific review of draft survey items, cognitive interviews with practicing physicians, a national physician survey, and psychometric analysis. Developing and testing measures of cultural competence and racial barriers in the patient-physician relationship will provide essential tools necessary to advance the study of racial disparities in health care. These measures will serve at least three crucial functions. First, they will allow us to empirically assess the role of physician bias, and other racial barriers in the patient-physician relationship, in explaining disparities in the quality of health care. Second, they will allow us to determine which (if any) facets of the broad concept of cultural competence reduce racial barriers and in turn reduce health care disparities. Both of these steps will help inform the content of cultural competence training and other interventions to reduce disparities. Finally, rigorously developed measures of racial barriers and cultural competence will provide needed evaluation tools for judging the effectiveness of cultural competence programs, many of which are currently being developed under NIH sponsorship. The aims of this project are to develop and test tools needed to explore the role of racial barriers in the patient- physician relationship as a source of disparities in the quality of health care, and the role of cultural competence among physicians as a means to mitigate those barriers. These tools are needed to inform and evaluate future interventions to reduce pervasive racial disparities in health care quality and outcomes.