Mitigating Structural Racism to Reduce Inequities in Sepsis Outcomes

减轻结构性种族主义以减少败血症结果的不平等

• 批准号: 10474773
• 负责人: Dowin Boatright
• 金额: $ 55.22万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10474773
• 关键词: Acute myocardial infarction; Address; Administrator; Affect; African American; American; Antibiotics; Automobile Driving; Awareness; Basic Science; Black American; Black Populations; Caring; Cause of Death; Cessation of life; Chest; Clinic; Clinical; Clinical Management; Collaborations; Communities; Complex; Data; Early identification; Evaluation; Feedback; Foundations; Functional disorder; Genetic Predisposition to Disease; Health; Health Care Costs; Health system; Healthcare; Hospital Mortality; Hospitals; Immune response; Incidence; Infection; Institution; Institutional Practice; Interruption; Intervention; Latinx; Latinx population; Leadership; Learning; Life; Literature; Measurable; Measurement; Measures; Methods; Mission; Names; National Institute of General Medical Sciences; Not Hispanic or Latino; Organ; Organizational Change; Organizational Culture; Outcome; Pathway interactions; Patient Preferences; Patients; Persons; Phase; Physicians; Play; Politics; Population; Positioning Attribute; Primary Prevention; Problem Solving; Public Policy; Quality of Care; Race; Reporting; Research; Risk; Role; Safety; Seminal; Sepsis; Standardization; Structural Racism; Surveys; System; Time; Time Series Analysis; United States National Institutes of Health; Work; anti-racism; base; care outcomes; college; community organizations; comparative; evidence base; experience; follow-up; health inequalities; hospital readmission; improved; innovation; leadership development; mortality; novel; prospective; psychologic; racial disparity; socioeconomic disadvantage; standard care; stem

PROJECT ABSTRACT Sepsis affects approximately 1.7 million patients in the US annually, is one of the leading causes of mortality, and is a major driver of US healthcare costs. African American/Black (AA/B) and LatinX populations experience higher rates of sepsis complications, deviations from standard care, and all-cause and sepsis readmissions compared with Non-Hispanic White (NHW) populations. Despite clear evidence of the ways in which structural racism compounds factors at the hospital and community levels to generate poorer sepsis care and outcomes for AA/B and LatinX patients, there are no evidence-based, prospective interventions to name and address structural racism in sepsis care, nor are we aware of studies that report reductions in racial inequities in sepsis care as an outcome. Naming and addressing the impact of structural racism on sepsis care will require collective action across health systems and community institutions, supported by ways of working (e.g., organizational culture) to collaborate effectively across historical, political, and organizational boundaries. Our prior research has shown that coalition-based leadership development approaches can be effective in cultivating organizational culture that can improve complex health outcomes. We propose to adapt, deliver, and evaluate a coalition-based intervention to equip health systems and their surrounding communities to name and address structural racism and drive measurable reductions in inequities in sepsis outcomes. Our specific aims are to: (1) Adapt and deliver a coalition-based leadership intervention in eight U.S. health systems and their surrounding communities to improve domains of organizational culture that are required to name and address structural racism; (2) Evaluate the impact of the intervention using a longitudinal, convergent mixed methods approach to quantify change in domains of organizational culture that are required to name and address structural racism using a novel survey instrument and describe the experience of culture change within each system, integrating quantitative and qualitative data at the analysis phase in order to develop a comprehensive understanding of the intervention impact and mechanisms by which the impact may have occurred; and (3) Evaluate the impact of the intervention on reduction of racial inequities in three clinical outcomes: a) early identification (time to antibiotic), b) clinical management (in-hospital sepsis mortality) and c) standards-based follow up (same-hospital, all-cause sepsis readmissions) using interrupted time series analysis and comparing clinical outcomes from systems that achieved meaningful change in domains of culture required to address structural racism with those that did not achieve meaningful change. The proposed study is timely, highly relevant, and fully aligned with calls to action by the NIH and the Sepsis Alliance to address inequities in sepsis care and outcomes. It is also highly innovative, as it would be the first to intervene prospectively to mitigate effects of structural racism by developing the domains of organizational culture that are required for anti-racist action, with implications for inequities in complex health outcomes beyond sepsis.

项目摘要 脓毒症每年影响美国约 170 万患者，是导致死亡的主要原因之一， 并且是美国医疗保健成本的主要驱动因素。非裔美国人/黑人 (AA/B) 和拉丁裔人群 脓毒症并发症、偏离标准护理以及全因脓毒症的发生率较高 与非西班牙裔白人 (NHW) 人群的再入院率相比。尽管有明确的证据表明 医院和社区层面的结构性种族主义复合了多种因素，导致败血症恶化 对于 AA/B 和 LatinX 患者的护理和结果，没有基于证据的前瞻性干预措施 指出并解决脓毒症护理中的结构性种族主义，我们也不知道有哪些研究报告种族歧视有所减少 结果是脓毒症护理的不平等。命名并解决结构性种族主义对脓毒症护理的影响 需要在工作方式的支持下，卫生系统和社区机构采取集体行动 （例如组织文化）跨越历史、政治和组织界限进行有效协作。 我们之前的研究表明，基于联盟的领导力发展方法可以有效地 培养可以改善复杂健康结果的组织文化。我们建议调整、交付和 评估基于联盟的干预措施，以装备卫生系统及其周边社区 解决结构性种族主义并显着减少败血症结果的不平等。我们的具体 目标是：(1) 在美国八个卫生系统中调整并实施基于联盟的领导干预措施， 他们周围的社区，以改善组织文化领域，需要命名和 解决结构性种族主义； (2) 使用纵向、收敛混合模型评估干预措施的影响 方法 量化组织文化领域变化的方法，需要命名和 使用新颖的调查工具解决结构性种族主义并描述文化变革的经历 在每个系统内，在分析阶段整合定量和定性数据，以便开发 全面了解干预影响以及影响可能产生的机制 发生； (3) 评估干预措施对减少三个临床中种族不平等的影响 结果：a) 早期识别（使用抗生素的时间），b) 临床管理（院内败血症死亡率）和 c) 使用中断时间序列进行基于标准的随访（同一医院、全因败血症再入院） 分析和比较在文化领域实现有意义变革的系统的临床结果 需要解决那些没有实现有意义变革的结构性种族主义问题。拟议的研究是 及时、高度相关且完全符合 NIH 和脓毒症联盟的行动呼吁，以解决 败血症护理和结果的不平等。它也具有高度创新性，因为它将是第一个干预的 通过发展组织文化领域，前瞻性地减轻结构性种族主义的影响 是反种族主义行动所必需的，这对败血症以外的复杂健康结果的不平等产生影响。