Measuring racial/ethnic discrimination in healthcare settings

描述(由申请人提供)：与非少数族裔患者相比，美国少数族裔患者的健康状况通常更差。尽管考虑到了保险覆盖范围、患者的健康行为、教育水平和收入或财富等重要因素，但各种族/族裔群体之间的健康和医疗保健不平等现象依然存在。越来越多的证据表明，歧视可能在造成和维持医疗保健利用和健康结果的差异方面发挥重要作用。几项研究得出结论，与非少数民族患者相比，种族/少数民族患者在医疗保健环境中互动时更有可能报告歧视经历。虽然现有的研究表明，患者对医疗保健环境中的歧视的看法是常见的和相关的，但不同研究之间的测量差异突显了从患者的角度对感知到的歧视进行标准测量的必要性。因此，我们对康涅狄格州的患者、医疗保健提供者、社区领导人和医疗保健管理人员进行了一系列面对面的关键线人访谈，以确定医疗保健环境中的歧视特征。我们的分析结果最终将为患者问卷的开发提供信息，该问卷可用于评估以患者为中心的护理、比较和报告绩效，并最终提高医疗保健组织内的护理质量。在这项申请中，我们特别建议：1)基于原始定性数据、专家小组评估、基于社区的小组输入、广泛的文献综述和对康涅狄格州社区居民的认知访谈，开发一套全面的问卷候选项目；以及2)现场测试这些项目，以评估我们在康涅狄格州住院医疗服务机构最近出院的患者样本中项目的初步数量特征。拟议的工作是制定标准化问卷的关键的第一步。为了扩大这一领域的证据基础，并为有效的干预措施提供信息，需要制定一项系统的战略，研究医疗保健组织中的患者对歧视的看法。 公共卫生相关性：现有研究表明，在医疗保健环境中感受到的种族/族裔歧视导致了健康方面持续存在的种族/民族差异，但在如何衡量感受到的歧视方面存在很大差异。开发和测试全面的题库是创建感知的医疗歧视的标准化衡量标准的重要基础，这是减少并最终消除医疗歧视对美国健康差距的任何贡献的关键一步。

DESCRIPTION (provided by applicant): Racial/ethnic minority patients in the United States typically have worse health outcomes when compared with their non-minority counterparts. Health and healthcare inequities across racial/ethnic groups persist despite taking into account important factors such as insurance coverage, patient health behaviors, level of education, and income or wealth. A growing body of evidence suggests that discrimination may play an important role in creating and sustaining differences in healthcare utilization and health outcomes. Several studies conclude that racial/ethnic minority patients are more likely to report discriminatory experiences when interacting within healthcare settings than non-minority patients. Although the existing research demonstrates that patient perceptions of discrimination within healthcare settings are common and relevant, the variation in measurement across studies highlights the need for a standard measurement of perceived discrimination from the patient perspective. We, therefore, conducted a series of in-person key informant interviews with a purposeful, racially/ethnically diverse sample of patients, healthcare providers, community leaders, and healthcare administrators across the state of Connecticut to characterize discrimination within healthcare settings. Our analyzed findings will ultimately inform the development of a patient questionnaire that can be used to assess patient-centered care, to compare and report on performance, and to ultimately improve the quality of care within healthcare organizations. In this application, we specifically propose to: 1) develop a comprehensive set of candidate items for the questionnaire based upon original qualitative data, expert panel evaluation, community-based panel input, extensive literature review, and cognitive interviews with community-dwelling participants across Connecticut; and 2) field test the items to assess preliminary quantitative characteristics of the items across our sample of recently-discharged patients from inpatient medicine services in Connecticut. The proposed work is the critical first step towards development of a standardized questionnaire. A systematic strategy towards the study of patient perceptions of discrimination across healthcare organizations is needed to expand the evidence base in this area and to inform effective interventions. PUBLIC HEALTH RELEVANCE: Existing research suggests that perceived racial/ethnic discrimination within healthcare settings contribute to persistent racial/ethnic disparities in health but there is wide variation in how perceived discrimination is measured. The development and testing of a comprehensive item pool is the essential groundwork towards creating a standardized measure of perceived healthcare discrimination, a critical step in reducing and eventually eliminating any contribution of healthcare discrimination to health disparities in the United States.