Improving Racial Equity in Clinical Decision Making about Access to Organ Transplant

改善器官移植临床决策中的种族平等

• 批准号: 10507407
• 负责人: Lisa M McElroy
• 金额: $ 13.17万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10507407
• 关键词: Attention; Black race; Cessation of life; Clinical; Cross-Sectional Studies; Data; Data Collection; Decision Making; Diagnostic tests; Disease; Educational Background; Electronic Health Record; Ethnic Origin; Evaluation; Focus Groups; Foundations; Funding; Future; Gender; Geography; Goals; Health system; Individual; Institutional Racism; Insurance Coverage; Intervention; Intervention Studies; Knowledge; Lead; Measures; Mediator of activation protein; Medicine; Mentors; Methods; Monitor; Nurses; Operative Surgical Procedures; Organ; Organ Transplantation; Outpatients; Patients; Persons; Phase; Plant Roots; Process; Quality of life; Race; Racial Equity; Research; Research Personnel; Social Work; Standardization; Surveys; System; Testing; Time; Training; Transplant Recipients; Transplantation; Transportation; United States; Waiting Lists; Work; acceptability and feasibility; black patient; clinical application; clinical decision-making; clinical practice; design; ethnic minority; improved; income insurance; meetings; multidisciplinary; optimal treatments; organ transplant recipient; patient screening; racial bias; racial disparity; racial minority; screening; skill acquisition; social health determinants; tool; transplant centers

PROJECT SUMMARY Organ transplantation is the optimal treatment for end stage organ disease and results in improved patient survival and quality of life. Black patients have rates of end stage organ disease nearly three times that of white patients, yet comprise only 20% of organ transplant recipients. The transplant selection process is not standardized across transplant centers and therefore decision making at each phase of the process is potentially vulnerable to institutional racism. Further, national transplant data collection and monitoring exclude the transplant selection process. The overall objective of this proposal is to identify, characterize, and intervene on inequities in organ transplant that occur due to health system processes which are vulnerable to interpersonal and institutional bias Our central hypothesis is that inadequate attention to equity promoting principles throughout each phase of the selection process are major contributors to inequitable access to organ transplant. This project will quantify racial inequities at each phase of the transplant selection process (screening, evaluation and committee decision making) using electronic health record data, characterize vulnerabilities in the transplant screening, evaluation and committee decision aming processes that contribute to overall inequities in access to transplant and design and pilot a toolkit to reduce inequities in the transplant screening, evaluation and committee decision making processes. This results of this project will elucidate the influence of institutional racism in transplant systems and processes on racial equity in access to transplant. The research and additional knowledge and skill development will form a strong foundation for the candidate’s transition to an independent investigator studying interventions to overcome institutionally biased practices which contribute to organ transplant inequities.

项目摘要 器官移植是针对末期器官疾病的最佳治疗方法，可改善患者的生存和 生活质量。黑人患者的终阶段器官疾病发生率几乎是白人患者的三倍，但完整 只有20％的组织移植受者。移植选择过程并非在移植中心中标准化， 因此，在过程的每个阶段做出决策都可能容易受到制度种族主义的影响。此外，国家 移植数据收集和监视不包括移植选择过程。该提议的总体目标 是识别，表征和干预因卫生系统过程而发生的器官移植的不平等 我们容易受到人际交往和机构偏见的损害我们的中心假设是对公平的关注不足 在选择过程的每个阶段促进原则是使组织不平等的主要因素 移植。该项目将在移植选择过程的每个阶段量化种族不平等（筛选， 评估和委员会决策）使用电子健康记录数据，表征 移植筛查，评估和委员会决策促进访问总体不平等的过程 移植，设计和试行工具包，以减少移植，评估和委员会的不平等现象 决策过程。该项目的结果将阐明机构种族主义在移植中的影响 种族平等的系统和流程，可以进入移植。研究以及其他知识和技能 开发将构成候选人向独立研究人员进行研究的强大基础 克服有助于器官移植不平等的机构有偏见的做法的干预措施。