RACE AND GENDER DIFFERENCES IN CLINICAL DECISION MAKING

在使用医疗方面的种族和性别差异，以及 特别是心脏手术，已经被广泛报道，但大多数研究 不要探究为什么存在这些差异。 该项目将研究 医生决策是否有助于种族和性别差异 冠心病的医疗护理模式。 具体来说，该项目将评估患者种族和 性别对医生估计疾病概率的影响 评估病人。 研究假设医生低估了 黑人与白人相比，女性与男性相比， 男性，医生有更高的阈值推荐诊断 黑人与白人相比，女性与男性相比。 将使用以下工具编写案例说明和调查工具： 交互式视频光盘技术。 病例描述中的患者将 不同的种族，心血管风险水平和类型， 胸痛 将招募医生参与研究， 三个专业的全国会议：家庭医学，内科学， 和心脏病学。 将向每位研究医生展示病例描述， 将被要求对患者报告的疼痛类型进行分类， 估计CAD的先验概率，以及是否将患者转诊 运动压力测试 在收到压力测试结果后， 将要求医生估计CAD的后验概率， 是否转诊患者进行冠状动脉造影。 医师 回答将用于检验研究假设。 这个为期三年的项目将由乔治敦大学的研究人员进行 他在宾夕法尼亚大学取得了学士学位。 的 该项目将提供深入了解医生决策的作用， 限制黑人和妇女接受心脏手术。 此外，本发明还提供了一种方法， 该项目将有助于我们了解 有前途的新技术--交互式视盘--在评估 患者特征对医生临床决策的影响。

Race and gender differences in the use of medical treatments, and especially cardiac procedures, have been widely reported, but most studies do not explore why these differences exist. This project will examine whether physician decision making contributes to race and gender difference in patterns of medical care for coronary artery disease (CAD). Specifically, the project will assess the impact of patients' race and gender on physicians' estimate of disease probability and decisions to evaluate patients. The study hypotheses are that physicians underestimate the risks of CAD in blacks compared with whites and in women compared with men, and that physicians have higher thresholds for recommending diagnostic procedures in blacks compared with whites and in women compared with men. Case descriptions and a survey instrument will be developed using interactive video disc technology. Patients in the case descriptions will differ in their race, level of cardiovascular risk profile, and type of chest pain. Physicians will be recruited to participate in the study at national meetings of three specialties: family medicine, internal medicine, and cardiology. Each study physician will be shown a case description and will be asked to classify the type of pain reported by the patient, to estimate the prior probability of CAD, and whether to refer the patient for exercise stress testing. After receiving stress test results, the physician will be asked to estimate the posterior probability of CAD and whether to refer the patient for coronary angiography. Physicians' responses will be used to test the study hypotheses. This three-year project will be conducted by investigators at Georgetown University, with a subcontract to the University of Pennsylvania. The project will provide insight into the role of physician decision making in limiting access to cardiac procedures among blacks and women. In addition, the project will contribute to our understanding of the usefulness of a promising new technology-interactive videodiscs--in assessing the influence of patients characteristics on physicians' clinical decisions.