Improving patient-provider communication to reduce mental health disparities

改善医患沟通以减少心理健康差异

基本信息

批准号：
10392910
负责人：
JOHANNE ELIACIN
金额：
--
依托单位：
RLR VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-03-01 至 2023-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10392910
关键词：
Address Affect Attention Caring Client satisfaction Clinical Code Communication Communication Research Conflict (Psychology)Consolidated Framework for Implementation Research Data Development Distress Effectiveness Empathy Ensure Ethnography Evidence based intervention Exclusion Feedback Focus Groups Fostering Foundations Future Goals Health Health Care Costs Healthcare Healthcare Systems Hybrids Intervention Intervention Trial Interview Investigator-Initiated Research Link Measures Mental Health Mental Health Services Methodology Methods Minority Minority Groups Outcome Patient Care Patient Participation Patient Self-Report Patient-Centered Care Patient-Focused Outcomes Patients Phase Pilot Projects Preparation Process Provider Quality of Care Randomized Controlled Trials Research Research Methodology Research Personnel Research Proposals Role Sampling Services Site Social Environment Specialist Statistical Data Interpretation Structure System Testing Training Universities Veterans Washington Work base cancer care cancer health disparity disparity reduction effective intervention ethnic difference ethnic minority evidence base experience future implementation health care disparity health care settings health communication health disparity health equity implementation barriers implementation framework implementation intervention implementation outcomes implementation science improved informant intervention delivery intervention effect medication compliance military veteran minority patient patient engagement patient oriented patient-clinician communication peer perceived discrimination pilot test programs provider-level barriers racial and ethnic racial difference racial minority satisfaction shared decision making skills social culture system-level barriers treatment as usual trial design

项目摘要

Reviews of disparities in the VA healthcare system showed that significant racial and ethnic healthcare disparities persist across all sections in the VA, which affect health care costs, quality of care, patient satisfaction, and the health of Veterans. Patient-provider communication has been identified as a significant contributor to health and mental healthcare disparities. Specifically, lower level of participation in shared decision-making (SDM) among racial and ethnic minority patients and providers’ lower level of empathy towards minority patients contribute to racial and ethnic differences in patient-provider communication. Despite robust evidence documenting the important role of poor communication in healthcare disparities, few interventions have been developed to improve patient-provider communication among minority groups. Moreover, interventions to reduce mental healthcare disparities are lacking. This study seeks to improve patient-provider communication, specifically minority Veterans’ participation in SDM to reduce mental health disparities. SDM is a patient-provider communication strategy, widely recognized for engaging patients in their own healthcare and is associated to positive patients’ health outcomes. Current efforts to improve patients’ participation in SDM, especially in mental healthcare, are limited by lack of understanding and integration of patients’ social contexts in their treatment, such as their lived experiences – an important barrier to address, and inadequate attention to precursors to SDM such as patient engagement. Therefore, the primary objectives of this study are to 1) (Aim 1) adapt the George Washington University (GWU) patient navigation intervention, a health disparity evidence-based intervention in cancer care, to increase minority Veterans’ participation in SDM; 2) (Aim 2) refine and evaluate the intervention; and 3) (Aim 3) use systems redesign methods to conduct pre-implementation planning to facilitate effective intervention implementation in VA mental health settings. We will use an ecological framework that emphasizes sociocultural contexts in health communication and the Consolidated Framework for Implementation Research (CFIR) to guide the development and implementation of the proposed intervention. To accomplish Aim 1, we will elicit iterative feedback from Veterans, providers, peers, and other stakeholders from multiple VA facilities within VISN 10, in conjunction with an ethnographic study of Veterans and peers in mental health services. In Aim 2, we will evaluate the intervention at one site on a sample of (N=50) Veterans and using a randomized controlled trial design that will consist of an experimental (intervention) and control (treatment as usual) groups. We will refine the intervention based on this pilot study, and lay the foundation for a multi-sited, hybrid I randomized controlled trial (RCT) to determine its effectiveness in improving patient activation, patient engagement, and SDM. In Aim 3, we will use system redesign methods, guided by CFIR, to conduct pre-implementation planning. We will assess systems- level processes that could impact the future implementation of the proposed intervention. Qualitative data from the study will be coded and analyzed using an inductive/deductive approach, informed by our ecological and CFIR frameworks. Statistical analyses of the self-reported measures will provide patient outcomes data. Findings from this study will contribute to the VA’s efforts to improve patient-provider communication and reduce VA mental healthcare disparities. This study could affect the delivery of mental healthcare to minority Veterans in the VA.

VA医疗保健系统中差异的评论表明，大量的种族和种族医疗保健在VA的所有各个部分中，差异都持续存在，这会影响医疗保健成本，护理质量，患者满意度和退伍军人的健康。患者提供者的沟通已被确定为重要的健康和心理保健分布的贡献者。具体而言，参与共享的较低级别种族和少数民族患者和提供者的较低同理心的决策（SDM）对少数族裔患者有助于在患者提供沟通方面的种族和种族差异。尽管强大的证据文档沟通不良在医疗保健分配中的重要作用，很少已经开发了干预措施来改善少数群体之间的患者沟通。此外，缺乏减少心理保健分配的干预措施。这项研究旨在改善患者提供者的沟通，特别是少数民族退伍军人的参与 SDM减少心理健康分布。 SDM是一种患者提供的沟通策略，广泛认可让患者参与自己的医疗保健，并与阳性患者的健康成果有关。当前的改善患者参与SDM的努力，尤其是在心理保健方面，受到了缺乏的限制了解和整合患者的社会环境，例如他们的现场经历 - 解决问题的重要障碍，不足以对SDM的前体（例如患者参与度）。因此，这项研究的主要目标是1）（目标1）适应乔治华盛顿大学（GWU）患者导航干预措施，一种基于健康差异的癌症护理干预措施，增加少数民族退伍军人参与SDM； 2）（目标2）完善并评估干预措施； 3）（目标3）使用系统重新设计方法进行实施前计划以促进有效干预在VA心理健康环境中实施。我们将使用一个生态框架，该框架强调健康交流中的社会文化背景合并实施研究框架（CFIR）指导开发和实施拟议的干预措施。为了完成目标1，我们将引起退伍军人，提供者，同行，以及VISN 10中多个VA设施的其他利益相关者，并与人种学研究精神卫生服务中的退伍军人和同伴。在AIM 2中，我们将评估一个地点的干预措施（n = 50）退伍军人的样本，并使用随机对照试验设计，该设计将由实验组成（干预）和控制（照常治疗）组。我们将根据这项试点研究来完善干预措施，并为多点混合I随机对照试验（RCT）奠定基础，以确定其有效性在AIM 3中，我们将使用系统重新设计方法，在CFIR的指导下，进行实施前计划。我们将评估可能的系统级流程影响拟议干预措施的未来实施。该研究的定性数据将使用归纳/演绎方法进行编码和分析，我们的生态和CFIR框架。自我报告措施的统计分析将为患者提供结果数据。这项研究的发现将有助于VA改善患者提供者的努力沟通并减少VA心理保健分布。这项研究可能会影响精神的交付弗吉尼亚州的少数民族退伍军人的医疗保健。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Healthcare Access and Delivery During the COVID-19 Pandemic for Black Veterans with Chronic Pain: a Qualitative Study.

DOI：
10.1007/s11606-022-07884-9
发表时间：
2023-03
期刊：
JOURNAL OF GENERAL INTERNAL MEDICINE
影响因子：
5.7
作者：
Matthias, Marianne S.;Burgess, Diana J.;Eliacin, Johanne
通讯作者：
Eliacin, Johanne

Exploring Factors Impacting the Implementation of Recovery-Oriented Treatment Planning on Acute Inpatient Mental Health Units.

探索影响急性住院精神卫生单位康复治疗计划实施的因素。

DOI：
10.1007/s10488-022-01237-8
发表时间：
2023
期刊：
Administration and policy in mental health
影响因子：
0
作者：
Shue,SarahA;Traylor,Morgan;Kukla,Marina;Salyers,MichelleP;Rollins,AngelaL;Henry,Nancy;Eliacin,Johanne;Garabrant,Jennifer;McGuire,AlanB
通讯作者：
McGuire,AlanB

Implementation and staff understanding of shared decision-making in the context of recovery-oriented care across US Veterans Health Administration (VHA) inpatient mental healthcare units: a mixed-methods evaluation.

DOI：
10.1136/bmjopen-2021-057300
发表时间：
2022-05-30
期刊：
BMJ OPEN
影响因子：
2.9
作者：
Eliacin, Johanne;Carter, Jessica;Bass, Emily;Flanagan, Mindy;Salyers, Michelle P.;McGuire, Alan
通讯作者：
McGuire, Alan

Pre-implementation Evaluation of PARTNER-MH: A Mental Healthcare Disparity Intervention for Minority Veterans in the VHA.

DOI：
10.1007/s10488-020-01048-9
发表时间：
2021-01
期刊：
ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH
影响因子：
2.6
作者：
Eliacin, Johanne;Matthias, Marianne S.;Burgess, Diana J.;Patterson, Scott;Damush, Teresa;Pratt-Chapman, Mandi;McGovern, Mark;Chinman, Matthew;Talib, Tasneem;O'Connor, Caitlin;Rollins, Angela
通讯作者：
Rollins, Angela

Supporting Veterans in Racial-Ethnic Minority Groups During Times of Social Unrest.

在社会动荡时期支持少数族裔群体的退伍军人。