Perceived Bias in Medical Care among Ethnically Diverse Adults with Diabetes

描述（由申请人提供）：本项目的目标是开发患者报告的措施，在他们遇到的医疗保健专业人员的感知偏见，检查这些措施的心理测量特性，并探讨偏见和歧视的看法对医生和患者之间的关系，包括信任和满意度与医疗保健的影响。这个项目将评估目前的措施感知偏见和开发的问题，可以用来引出病人的看法，种族或种族偏见的医疗保健。改进后的问题，以衡量患者的偏见的看法将是特定的医疗保健，适用于任何健康状况，并适合于任何种族群体。使用一系列有针对性的小组访谈和两轮认知访谈与非裔美国人，拉丁美洲人和非西班牙裔白人，我们将评估患者的偏见经验，检查他们对调查问题的理解，探索他们如何回应有关偏见的问题，并制定和修改问题，必要时。我们将根据CAHPS门诊护理调查进行一项调查的试点测试，该调查包括一个关于医疗服务偏见问题的补充模块。试点测试将在两个联邦资助的健康中心进行，这些中心为不同种族的人群提供服务。我们将评估有关偏见问题的心理测量学特性，包括信度、内容效度和结构效度。采用一个概念模型，嵌入感知偏见的干预影响医患关系，我们将测试的假设，患者报告的经验偏见有较少的信任，在医疗保健专业人员，随后较少遵守医疗建议和较差的自我管理疾病。本项目开发的调查工具可用于改善患者与医疗保健专业人员之间的沟通。一个简短的调查问题模块，以引起患者报告的偏见，在医疗保健将被用来评估之间的关联感知偏见，信任卫生专业人员，参与决策，并坚持推荐的糖尿病治疗。这些新的工具来衡量医疗保健中的偏见，可用于监测干预措施后，病人的看法的变化，以培训和教育病人和卫生专业人员。在美国，健康差异是一个严重的公共卫生问题。与非西班牙裔白人相比，非裔美国人和拉丁美洲人的糖尿病相关死亡率一直较高。患者对偏见的看法可能是患者与卫生专业人员之间建立有效关系的障碍。该项目将创建新的方法来收集有关患者报告的医疗偏见的信息。

DESCRIPTION (provided by applicant): The goals of this project are to develop patient-reported measures of perceived bias in their encounters with health care professionals, to examine the psychometric properties of these measures, and to explore the effect of perceptions of bias and discrimination on relations between doctors and patients, including trust and satisfaction with health care. This project will assess current measures of perceived bias and develop questions that can be used to elicit patient perceptions of ethnic or racial bias in medical care. The improved questions to measure patient perceptions of bias will be specific to medical care, applicable to any health condition, and appropriate for any ethnic group. Using a series of focused group interviews and two rounds of cognitive interviews with African Americans, Latinos, and non-Hispanic whites, we will assess patients' experiences with bias, examine their understanding of survey questions, explore how they respond to questions about bias, and develop and revise questions, as necessary. We will field a pilot test of a survey based on the CAHPS Ambulatory Care survey that includes a supplemental module of questions about bias in medical care. The pilot test will be conducted in two federally-funded health centers that serve ethnically diverse populations. We will assess the psychometric properties of questions about bias, including reliability, content validity, and construct validity. Employing a conceptual model that embeds perceived bias as an intervening influence on the patient-physician relationship, we will test the hypothesis that patients reporting experiences of bias have less trust in health care professionals and subsequently less adherence to medical advice and poorer self management of disease. Survey tools developed in this project may be used to improve communication between patients and health care professionals. A short module of survey questions to elicit patient reports of bias in medical care will be used to assess the association among perceived bias, trust in health professionals, participatory decision making, and adherence to recommended treatment of diabetes. These new tools to measure bias in medical care can be used to monitor change's in patient perceptions after interventions to train and educate both patients and health professionals. Disparities in health are a severe public health problem in the United States. Compared with non-Hispanic whites, diabetes-related death rates are consistently higher for African American and Latinos. Patients' perception of bias is a likely barrier to developing effective relations between patients and health professionals. This project will create new methods to collect information about patient reports of bias in medical care.