Hidden in Plain Sight: Stigmatizing Language in Patient Medical Records

隐藏在众目睽睽之下：患者病历中的污名化语言

• 批准号: 10538612
• 负责人: MARY CATHERINE BEACH
• 金额: $ 68.44万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2026-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10538612
• 关键词: Affect; Age; Agreement; Algorithms; Area; Attention; Attitude; Behavior; Bypass; Canis familiaris; Caring; Categories; Clinical; Communication Methods; Computerized Patient Records; Consensus; Disparity; Drug Prescriptions; Education; Elderly; Equity; Feedback; Focus Groups; Gender; Goals; Health Professional; Health system; Healthcare; Healthcare Systems; Impaired health; Individual; Judgment; Language; Measures; Medical; Medical Records; Natural Language Processing; Obesity; Pathway interactions; Patients; Pattern; Persons; Physicians; Politics; Punishment; Quality of Care; Race; Reading; Records; Role; Sickle Cell Anemia; Social Class; Social status; Speech; Stereotyping; Stigmatization; Substance Use Disorder; Taxonomy; Testing; Vision; Work; Writing; disparity reduction; ethnic identity; health care quality; health literacy; implementation science; implicit bias; improved; individual patient; low health literacy; medical specialties; oral communication; patient health information; pilot test; racial disparity; sex; substance abuser; transmission process

ABSTRACT Our healthcare system does not treat patients equally: some receive poorer quality care based on their racial/ ethnic identity, social class, health literacy, age, gender or medical conditions such as obesity, sickle cell disease, and substance use disorders. While there may be many factors that contribute to these disparities, implicit bias among clinicians is one important factor that remains difficult to measure. Clinicians may convey and acquire bias towards patients from each other when communicating orally or when writing/reading medical records. Although medical records are an integral method of communicating about patients, few studies have evaluated patient records as a means of transmitting bias from one clinician to another. Our own preliminary work has found that language used in medical records has a direct influence on subsequent clinicians who read the notes, both in terms of their attitudes towards the patient and their medication prescribing behavior; that there are racial disparities in the use of stigmatizing language; and that this language reflects actual attitudes held by the clinicians. This is an important and overlooked pathway by which bias can be passed from one clinician to another, further impairing healthcare quality for the individual patient as well as exacerbating disparities overall for those who are stigmatized. Our overarching goal is to improve the quality and equity of care for persons who are disrespected and stigmatized in healthcare. The specific aims of this proposal are: (1) to define and develop a taxonomy of stigmatizing language in medical records using qualitative analyses with input from clinicians and patients across 5 different medical specialty areas, (2) to measure and test for bias in the use of stigmatizing language in medical records using natural language processing (NLP) that can efficiently detect and quantify stigmatizing language in electronic patient records, and then (3) to reduce stigmatizing language in medical records using proven implementation science (IS) strategies (stakeholder engagement, education, audit and feedback, and champions) to motivate and enable health system change. Every encounter with a patient is documented in the medical record. Because language may have a powerful role in influencing subsequent clinician attitudes and behavior, attention to the language used in medical records could have a large impact on the promotion of respect and reduction of disparities for stigmatized groups.

抽象的 我们的医疗保健系统不会平等治疗患者：有些人根据种族/ 种族认同，社会阶层，健康素养，年龄，性别或医疗状况，例如肥胖，镰状细胞疾病， 和药物使用障碍。虽然可能有许多因素导致这些差异，但隐性偏见 在临床医生中，仍然很难衡量的一个重要因素。临床医生可以传达和获取 口头交流或写/阅读医疗记录时，彼此偏见。 尽管医疗记录是关于患者进行交流不可或缺的方法，但很少有研究评估 患者记录是将偏见从一个临床医生传播到另一个临床医生的手段。我们自己的初步工作 发现医疗记录中使用的语言对阅读笔记的后续临床医生有直接影响， 在他们对患者的态度和药物处方行为方面；有种族 使用污名语言的差异；这种语言反映了该语言的实际态度 临床医生。这是一个重要且忽视的途径，可以通过一个临床医生将偏见传递给 另一个进一步损害了个体患者的医疗质量，并加剧了整体差异 对于那些受到污名的人。我们的总体目标是提高对那些人的质量和公平性 在医疗保健中受到尊重和污名化。该提案的具体目的是：（1）定义和发展 临床医生的意见和 跨5个不同医学专业领域的患者，（2）测量和测试使用污名化的偏差 使用自然语言处理（NLP）的医疗记录中的语言可以有效地检测和量化 电子记录中的污名语言，然后（3）减少医学中的污名化语言 使用经过验证的实施科学（IS）策略的记录（利益相关者参与，教育，审计和 反馈和冠军）激励和实现卫生系统的变化。每次与患者的相遇是 记录在病历中。因为语言可能在影响后续的 临床医生的态度和行为，对病历中使用的语言的关注可能会对 促进尊重和减少污名群体的差异。