Understanding Racial/Ethnic Disparities in Uterine Fibroid Outcomes among Women Veterans: A mixed-methods study

了解女性退伍军人子宫肌瘤结果的种族/民族差异：一项混合方法研究

• 批准号: 10541797
• 负责人: Lisa Susanne Callegari
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10541797
• 关键词: Abdomen; Accounting; Address; Affect; Age; Anemia; Area; Behavior Therapy; Black Populations; Black race; Blood Transfusion; Caring; Clinical; Cohort Analysis; Complex; Data; Decision Making; Development; Diagnosis; Emergency department visit; Ensure; Fibroid Tumor; Future; Gender; Goals; Gynecologic; Gynecology; Health Care Research; Healthcare; Healthcare Systems; Hemorrhage; Hospitalization; Hysterectomy; Incidence; Intervention; Medical; Medical Records; Methods; Newly Diagnosed; Non-Malignant; Operative Surgical Procedures; Outcome; Pain; Pathway interactions; Patient Preferences; Pattern; Pelvis; Policies; Procedures; Process; Provider; Public Health; Race; Recovery; Reproduction; Research; Research Personnel; Research Priority; Retrospective cohort; Role; Sampling; Severities; Shapes; Social Environment; Structure; Surgical complication; Symptoms; Time; Translating; Treatment outcome; Uterine Fibroids; Veterans; Woman; Women' s Health; Women' s Health Services; Work; base; black patient; black women; black/white disparity; care outcomes; care seeking; clinical care; clinical decision-making; cohort; common treatment; cost; data warehouse; design; disabling symptom; disparity elimination; disparity reduction; experience; fertility preservation; health care availability; health care model; health equity; hospital readmission; innovation; intervention program; minimally invasive; patient oriented; policy recommendation; preference; pressure; programs; racial and ethnic disparities; racial difference; racial health disparity; racism; reproductive; social; surgery outcome; surgical risk; therapy development; treatment disparity

Background: Uterine fibroids (UF) are a common and costly gynecologic condition that disproportionately affect Black women with regard to incidence, severity, treatment, and outcomes. UF result in debilitating symptoms including pelvic pressure and pain, problems with reproduction, heavy menstrual bleeding, and severe anemia, and are the leading cause of hysterectomy among women Veterans in VA. Although VA is a model healthcare system regarding health equity in many areas, recent data suggest that substantial Black/White disparities in UF treatment and outcomes exist within VA. As one-third of women Veterans using VA health care are Black and this proportion is increasing, understanding the underlying drivers of these disparities within VA is of critical importance. Limited research has examined these mechanisms either outside or within VA. Building a comprehensive understanding of UF disparities and potential opportunities to address them will require examining the role of race and racism in women Veterans’ pathways to diagnosis and treatment of UF and their UF treatment patterns and experiences. Objectives: Our objective is to investigate the mechanisms underlying Black/White disparities in UF-related outcomes among women Veterans receiving VA care. Guided by the Public Health Critical Race Praxis, which asserts that race is a social construct and that ubiquitous patterns and structures of contemporary racism shape racial disparities in health, we propose: (1) To examine Black/White differences in treatment patterns for women Veterans with UF and identify modifiable determinants; (2) To examine Black/White differences in clinical and post-surgical outcomes among women Veterans receiving treatment for UF in VA and identify modifiable determinants; and (3) To understand and contextualize differences identified in Aims 1 and 2 using qualitative exploration of Black women Veterans’ experiences with UF symptoms, care seeking behaviors, and treatment and how they differ from those of White women Veterans. Methods: We will use a mixed methods approach to address our study objectives. All three aims, will draw from a single cohort of Black and White women Veteran users of VA healthcare with newly diagnosed symptomatic UF between Fiscal Year 2010 (FY10) and FY12, identified through the Corporate Data Warehouse (CDW). Aims 1 and 2 are retrospective cohort analyses. We will examine administrative data and chart-abstracted medical record data through FY18 to compare Black/White differences in treatment and outcomes. Aim 1 will compare time from diagnosis to initial treatment and surgical treatments; type of initial treatment (medical, non-definitive procedure, hysterectomy); and mode of surgery (minimally invasive vs abdominal). Aim 2 will examine Black/White differences in clinical (emergency room visits, hospitalization for anemia, blood transfusion) and surgical outcomes (surgical complications, 30-day readmission) for UF. Aim 3 is a qualitative study with a purposively selected sample of up to 30 Black and 30 White women Veterans to inform and contextualize our quantitative findings from Aims 1 and 2. Content analysis will be used to understand and identify how the constructs of race and gender may interact to impact women Veterans’ experiences with UF, pathways to treatment, treatment decision making, and treatment patterns. Our dissemination plan includes a stakeholder engagement process which will engage Veterans, providers, and operational partners in translating our findings into actionable practice and policy recommendations to reduce disparities. Innovation and Next Steps: This proposal addresses key HSR&D priorities of women’s health, health equity, and healthcare access. The innovative approach ensures substantial impact by moving beyond documenting racial/ethnic disparities to building understanding of underlying and potentially modifiable causes. Next steps following completion of the research and stakeholder engagement process will include partnering with VA Women’s Health Services and VA Office of Health Equity to develop targeted interventions, programs, and policies to address UF disparities. Ultimately, this research has the potential to accelerate progress towards quality and equity in gynecology and reproductive healthcare both within and beyond VA.

背景：子宫肌瘤（UF）是一种常见且昂贵的妇科疾病，对黑人的影响尤为严重 女性的UF会导致包括骨盆在内的衰弱症状。 压力和疼痛、生殖问题、大量月经出血和严重贫血，是主要的 退伍军人管理局女性退伍军人接受子宫切除术的原因 尽管退伍军人管理局是健康方面的模范医疗保健系统。 许多领域的公平性，最近的数据表明，UF 治疗和结果方面存在巨大的黑人/白人差异 在 VA 内，使用 VA 医疗保健的女性退伍军人中有三分之一是黑人，而且这一比例还在增加， 了解 VA 内部这些差异的根本驱动因素至关重要。 研究了 VA 外部或内部的这些机制，以全面了解 UF 的差异。 解决这些问题的潜在机会将需要审查种族和种族主义在女性退伍军人中的作用 UF的诊断和治疗途径及其治疗模式和经验。 目标：我们的目标是调查 UF 相关结果中黑人/白人差异的潜在机制 接受退伍军人事务部护理的女性退伍军人以公共卫生关键种族实践为指导，该实践主张种族。 是一种社会建构，当代种族主义无处不在的模式和结构塑造了种族差异 健康方面，我们建议：(1) 检查黑人/白人在治疗患有 UF 的女性退伍军人和 (2) 检查黑人/白人在临床和术后结果方面的差异 在 VA 接受 UF 治疗的女性退伍军人并确定可改变的决定因素；以及 (3) 了解和 通过对黑人女性退伍军人的定性探索，将目标 1 和 2 中确定的差异置于背景中 UF 症状、寻求护理行为和治疗的经历以及它们与白人有何不同 女退伍军人。 方法：我们将使用混合方法来实现我们的所有三个目标。 VA 医疗保健的黑人和白人女性退伍军人用户新诊断出有症状的 UF 的单一队列 2010 财年 (FY10) 和 2012 财年之间的数据，通过公司数据仓库 (CDW) 目标 1 和 2 确定。 是回顾性队列分析，我们将检查管理数据和图表抽象医疗记录数据。 通过 2018 财年比较黑人/白人在治疗和结果方面的差异，目标 1 将比较诊断后的时间。 初始治疗和手术治疗；初始治疗的类型（医疗、非确定性手术、子宫切除术）； 和手术方式（微创手术与腹部手术）。目标 2 将检查临床上的黑人/白人差异。 （急诊室就诊、贫血住院、输血）和手术结果（手术并发症、 UF 目标 3 是一项定性研究，有目的地选择最多 30 名黑人和 30 名样本。 白人女性退伍军人为我们的目标 1 和 2 的定量发现提供信息和背景。内容分析将 用于理解和确定种族和性别的结构如何相互作用以影响女性退伍军人 UF 的经验、治疗途径、治疗决策和治疗模式。 计划包括一个利益相关者参与流程，该流程将让退伍军人、提供商和运营合作伙伴参与其中 将我们的发现转化为可操作的实践和政策建议，以减少差距。 创新和后续步骤：该提案解决了妇女健康、健康公平和 创新方法超越记录种族/民族的范围，确保产生重大影响。 完成后的后续步骤对建立对根本原因和潜在可改变原因的理解存在差异。 研究和利益相关者参与过程将包括与退伍军人管理局妇女健康服务机构合作， 退伍军人事务部健康公平办公室制定有针对性的干预措施、计划和政策，以解决 UF 的差异。 最终，这项研究有可能加速妇科和妇科领域质量和公平方面的进展。 弗吉尼亚州内外的生殖保健。