COmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP)

项目总结 心血管疾病(CVD)是导致预期寿命和 不受控制的高血压是造成这种差异的关键风险因素。尽管有干预措施需要克服 高血压控制的障碍，越来越多的证据表明，善意的、平等的提供者 可能存在影响患者互动、临床决策和治疗效果的隐性偏见 旨在缓解跨文化差异的干预措施。我们提出了一个名为社区参与的计划 血压控制模拟训练(Consult-BP)--一种以理论为基础、多组分的训练 针对实习医生和实习护生的干预措施。咨询-BP将适应并测试A 以理论为基础，以意识、暴露和技能培养为基础的干预，应用于基于模拟的安全 学习中心，以提高提供者与少数族裔和贫困患者的互动技能。我们将使用我们的 建立以社区为基础的参与式研究平台，以实施咨询-BP 学术医疗中心有一个大型的安全网医疗系统，为少数族裔和贫困人口服务。这个 咨询-BP项目将：1.招募和聘用代表不同弱势群体的社区顾问(CA) 将参与适应循证高血压传播工具的人群和 设计、开发和实施培训课程；2.使用在线自我评估 临床医生对种族和患者依从性的内隐偏见以提高偏见自我意识并检查 偏见对知识和技能发展的影响；以及3.聘请社区SP(A)进行面对面的讨论， 与医学实习生和NP学生进行模拟临床会诊，并(B)提供评估和 与训练有素的CA观察员和教员协调人一起反馈沟通技巧。教育性的 干预是一个两个90分钟的课程，相隔5周，将在线学习与 面对面的技能练习。了解需要多少训练暴露才能使临床医生“动一动针” 技能和患者预后，我们将通过进行两个、连续的、 随机试验。试验1将评估一次性咨询培训的效果，以及 试验2将评估重复强化训练对结果的影响。支持培训的可行性 试验1，咨询-BP将在3年内培训IM、FM和NP实习生队列，并将目标 在某一学年内接受过一次性培训的高级(二年级或三年级)学员 干预。在每个学年内，我们将随机安排培训时间到5个开始日期中的一个，使用Step 楔形设计，以适应预先存在的培训计划，并缓解时间趋势的影响 临床技能熟练。试验2将从试验1到试验2随机分配继续受训人员 咨询-BP助推器培训暴露与没有助推器培训。两项试验的主要结果都将是 保持耐心的血压控制。次要流程结果将包括学员的沟通技能和耐心 坚持服药、就诊和改变饮食。我们还将检查患者对效果的修改 特征(基线血压控制)和受训者特征(隐性偏见和对偏见的认识)。实习生 措施将来自学员自我报告(隐性偏见、偏见意识)、社区SP报告(学员 沟通技能)和临床患者调查(学员沟通质量和患者忠诚度)。 临床BP结果将来自EMR。我们将使用分析性混合效应模型来考虑患者 和临床医生特征、随机群组内和临床医生内的患者相关性，以及 在患者内部重复测量。咨询-BP多阶段、社区参与的教育模式将 改变医学教育工作者关于帮助提供者培养有偏见意识、以患者为中心、 沟通技巧。

PROJECT SUMMARY Cardiovascular disease (CVD) is a leading contributor to racial disparities in life expectancy and uncontrolled hypertension is a critical risk factor underlying this disparity. Despite interventions to overcome barriers to hypertension control, accumulating evidence demonstrates that well-meaning, egalitarian providers can harbor implicit biases that affect patient interactions, clinical decision-making, and the effectiveness of interventions to mitigate cross-cultural differences. We propose a program called COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP), a theory-based, multi-component, training intervention that targets medical residents and nurse practitioner students. CONSULT-BP will adapt and test a theory-based, `awareness, exposure and skill-building' intervention, applied in the safety of a simulation-based learning center, to improve providers' interaction skills with minority and poor patients. We will use our established platform of community-based participatory research to implement CONSULT-BP in an academic medical center with a large, safety-net health system that serves a minority and poor population. The CONSULT-BP project will: 1. recruit and hire Community Advisors (CA) representing diverse underserved populations who will participate in the adaptation of evidence-based hypertension communication tools and the design, development, and implementation of the training curriculum; 2. use online self-assessments of clinicians' implicit bias for race and patient compliance to raise bias self-awareness and to examine the effect of bias on knowledge and skill development; and 3. hire Community SPs to (a) conduct face-to-face, simulated clinical encounters with medical trainees and NP students, and (b) provide evaluation and feedback about communication skills along with trained CA observers and faculty facilitators. The educational intervention is a program of two, 90-minute, sessions, spaced 5 weeks apart that combine online learning with in-person skill practice. To understand how much training exposure is required to `move the needle' of clinical skills and patient outcomes, we will assess the effect of CONSULT-BP by conducting two, sequential, randomized trials. Trial 1 will evaluate the effectiveness of one-time CONSULT training on outcomes, and Trial 2 will evaluate the effect of repeat, booster training on outcomes. To support training feasibility in Trial 1, CONSULT-BP will train cohorts of IM, FM, and NP trainees over a 3-year period, and will target advanced (2nd or 3rd-year) trainees within a given academic year for one-time exposure to the training intervention. Within each academic year, we will randomize training times to 1 of 5 start dates using a stepped wedge design to accommodate pre-existing training schedules and to mitigate the effect of temporal trends in clinical skill proficiency. Trial 2 will randomly assign continuing trainee participants from Trial 1 to a second CONSULT-BP booster training exposure versus no booster training. The primary outcome for both trials will be patient BP control. Secondary process outcomes will include trainees' communication skills and patient adherence to medications, visits, and diet changes. We will also examine effect modification by patient characteristics (baseline BP control) and trainee characteristics (implicit bias and awareness of bias). Trainee measures will be from trainee self-report (implicit bias, bias awareness), community SP report (trainee communication skills), and clinic patient surveys (trainee communication quality and patient adherence). Clinical BP outcomes will be from the EMR. We will use analytic mixed effect models accounting for patient and clinician characteristics, patient correlations within randomization clusters and within clinicians, and repeated measures within patient. The CONSULT-BP multi-staged, community-engaged, education model will change how medical educators think about helping providers develop bias-aware, patient-centered, communication skills.