Motivating providers to reduce racial disparities in their own practice

激励提供者在自己的实践中减少种族差异

• 批准号: 8695117
• 负责人: Diana J Burgess
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-01 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8695117
• 关键词: Address; Area; Awareness; Belief; Belief System; Caring; Cataloging; Catalogs; Clinical; Communication; Consensus; Educational workshop; Effectiveness; Employee; Goals; Guidelines; Health Personnel; Healthcare; Healthcare Systems; Individual; Inequality; Intervention; Interview; Intranet; Knowledge; Language; Lead; Learning; Mails; Measures; Methods; Minority; Motivation; Online Systems; Patient Noncompliance; Patients; Persuasive Communication; Policies; Provider; Qualitative Methods; Quality of Care; Readiness; Reading; Reporting; Research; Resistance; Services; Site; Social Marketing; Structure; Surveys; Testing; Training; Training Activity; Training Programs; Veterans; Work; base; behavior change; design; follow-up; health care quality; improved; innovation; insight; phase 1 study; programs; racial difference; research study; response; screening; skills; systematic review

DESCRIPTION (provided by applicant): Anticipated Impacts on Veterans Healthcare. Our long-term goal is to eliminate the provider contribution to racial disparities in access to and quality of care. The work proposed in this stud is an essential step in pursuit of that goal, as it is expected to result in knowledge about how to increase provider readiness to engage in actions to reduce healthcare disparities. Project deliverables are aimed at motivating providers to participate in programs designed to raise awareness and build skills to reduce healthcare disparities. Project deliverables include: 1) tailored narratives customized according to different healthcare inequality beliefs (for use in educational approaches, such as web-based training, where individually tailored training through branching is technically possible); 2) untailored narratives designed to enhance motivation for all providers, regardless of underlying beliefs (for use in situations where tailorig is not possible, such as Grand Round presentations) and 3) a communication toolkit, cataloging communication and intervention strategies to reduce disparities. Background. Racial disparities have been documented extensively both within and outside the Veteran Affairs healthcare system across a wide range of clinical areas and service types. Although a number of factors have been shown to contribute to disparities, including site of care, recent reports have concluded that healthcare providers likely contribute to a portion of these disparities. There is broad consensus that increasing the ability of clinicians and other healthcare employees to address disparities is a critical part of eliminating disparities, and there has been a surge of training activities and programs in response. What is missing, however, are empirically-based communication strategies for getting providers motivated to reduce disparities, particularly the sizable number that do not believe that providers contribute to racial differences in healthcare quality and who, due to a larger system of beliefs, might be resistant to messages about their own potential to contribute to disparities. This gap is a significant impediment to the successful implementation of disparities-reduction training programs aimed at providers, as motivation has been shown to be a critical piece of behavior change. Objectives. Aim 1 is to conduct semi-structured interviews with two groups of providers, stratified by whether they attribute healthcare inequalities more to factors internal or external to patients, to explore provider responses to narratives that vary in the extent to which external causes of healthcare disparities are emphasized. Aims 2a and 2b are to use a factorial experiment to test the hypothesis that narratives that are congruent with providers' beliefs about the cause of racial differences in healthcare quality will be most effective at increasing (2a) providers' readiness to take action to reduce disparities and (2b) providers' participation in one of two online "disparities reduction" training programs. Aim 2c is to identify the narrative type that leads to the highest level of participation in disparities-reduction training across all providers. Methods. Aim 1 will be addressed through a qualitative study (Phase 1) consisting of individual interviews with providers from 3 VA facilities (N = 60). Providers will be preselected based on their beliefs ascertained through a brief mixed-mode survey (intranet survey with mail follow-up) containing a screening question assessing providers' attributions of healthcare inequality and the interviews will be stratified into those two groups based on their responses to that screening question. Interviews will be transcribed and analyzed. This survey will also contain items that will be used to validate the screening question. For Aim 2 we will conduct a factorial experiment (intranet survey with mail follow-up), where VA providers will complete the screening question, read one of 2 types of narratives, learn about actions providers can take to reduce disparities, complete a measure assessing readiness to take action to reduce disparities, and receive an invitation to participate in disparities- reduction training programs. Participation will be assessed with a follow-up survey a month after completion of the initial survey.

描述（由申请人提供）： 对退伍军人医疗保健的预期影响。我们的长期目标是消除提供者对获得和护理质量的种族差异的贡献。该螺柱中提出的工作是追求该目标的重要步骤，因为它预计会导致有关如何进行的知识 提高提供者准备工作以减少医疗保健差异的行动。项目可交付成果旨在激励提供者参与旨在提高认识和建立技能以减少医疗保健差异的计划。项目可交付成果包括：1）根据不同的医疗保健不平等信念定制的量身定制的叙述（用于教育方法，例如基于Web的培训，在技术上可以通过分支进行单独量身定制的培训）； 2）旨在增强所有提供者动机的未尾声叙事，无论其潜在的信念如何（在不可能的情况下使用，例如大回合演讲）和3）3）沟通工具包，分类沟通和干预策略以减少差距。背景。在广泛的临床领域和服务类型中，在资深事务医疗体系内外，种族差异已被广泛证明。尽管已显示许多因素会导致差异，包括护理现场，但最近的报告得出结论，医疗保健提供者可能有助于这些差异的一部分。有广泛的共识是，提高临床医生和其他医疗保健解决差异的能力是消除差距的关键部分，并且有大量的培训活动和计划的回应。然而，缺少的是基于经验的沟通策略，以使提供者有动力减少差异，尤其是不认为提供商会导致医疗保健质量的种族差异，并且由于更大的信念体系，他们可能会对自己的潜力有助于差异。这一差距是成功实施针对提供者的差异培训计划的重大障碍，因为已经证明动机是行为的关键变化。目标。 AIM 1是对两组提供商进行半结构化访谈，根据他们是否归因于医疗保健进行了分层 对患者内部或外部因素的不平等，探索提供者对叙事的反应，这些叙述在强调医疗保健差异的外部原因的程度上有所不同。目标2a和2b是使用阶乘实验来检验以下假设：与提供者对医疗保健质量种族差异的信念一致的叙事将对增加（2a）提供者准备采取行动以采取行动最有效 减少差异和（2B）提供商参与两个在线“降低差异”培训计划之一。 AIM 2C是确定导致所有提供者中最高参与差异培训的叙事类型。方法。 AIM 1将通过定性研究（第1阶段）来解决，该研究包括与来自3个VA设施的提供者的个人访谈（n = 60）。提供者将根据他们的信念通过简短的混合模式调查（Intranet调查进行邮件随访）确定，其中包含一个筛查问题，该问题评估了提供者对医疗保健不平等的归因，并根据对该筛查问题的回答将访谈分为两组。访谈将被转录和分析。该调查还将包含用于验证筛查问题的项目。对于AIM 2，我们将进行一项阶乘实验（对邮件随访的Intranet调查），VA提供者将完成筛查问题，阅读两种叙述之一，了解提供者可以采取的行动来减少差异，完成一项评估准备就绪以采取行动以减少差异的措施，并接受邀请参加障碍，以参与偏低培训计划。初步调查完成后一个月，将通过一项随访调查来评估参与。