Gender Disparities in Invasive CVD Procedure Use: the Role of Provider Bias

侵入性 CVD 手术使用中的性别差异：提供者偏见的作用

• 批准号: 8312535
• 负责人: Stacie Luther Daugherty
• 金额: $ 13.15万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-20 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8312535
• 关键词: Address; Angiography; Area; Attitude; Belief; Cardiac; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caring; Clinical; Clinical Data; Colorado; Commit; Complication; Conscious; Coronary Arteriosclerosis; Data; Development; Ensure; Evaluation; Evidence based intervention; Female; Foundations; Functional disorder; Gender; General Population; Goals; Health Personnel; Health Services; Health Services Research; Healthcare; Implicit Association Test; Institute of Medicine (U.S.); Institutes; Interview; K-Series Research Career Programs; Knowledge; Left; Link; Literature; Measurement; Measures; Mentors; Mentorship; Modeling; Nuclear; Occupations; Outcome; Patients; Performance; Positioning Attribute; Primary Prevention; Procedures; Provider; Qualifying; Qualitative Research; Recommendation; Research; Research Methodology; Research Personnel; Research Project Grants; Research Training; Resources; Risk Behaviors; Role; Sex Bias; Sex Characteristics; Social Psychology; Socioeconomic Factors; Stereotyping; Stress Tests; Structure; Surveys; Techniques; Testing; Time; Training; Training Activity; Unconscious State; Universities; Ventricular; Woman; base; career; career development; cohort; experience; health disparity; instrument; male; men; multi-component intervention; skills; social; success; therapy design; tool; trait; willingness

PROJECT SUMMARY/ABSTRACT My long-term career goal is to become a nationally recognized independent investigator and expert in cardiovascular disease (CVD) disparities with an emphasis on interventions designed to eliminate disparities. I have laid a strong foundation for reaching this goal by defining a broad mentoring network, obtaining formal training in health services research, and leading several research projects. To date, my research has primarily focused on describing gender disparities in CVD care. For example, I have shown that women with CVD receive fewer invasive procedures than men with CVD. Despite extensive research documenting these disparities, few have investigated their causes. I am committing my career to addressing this gap by conducting research aimed at understanding the mechanisms behind gender disparities to achieve my ultimate goal of instituting evidence-based interventions to reduce gender disparities in CVD care. The Institute of Medicine has identified provider bias as a key contributor to disparities in health care. However, the role of provider bias in gender-based decisions surrounding the use of invasive CVD procedures is poorly characterized. In order to more accurately and fully measure provider attitudes, advanced qualitative and social psychology techniques must be employed; skills I wish to develop. Therefore, I seek a Career Development Award to allow me time and support to pursue mentored research aimed at measuring provider gender attitudes and training in the areas of qualitative research, social psychology and advanced biostatistical techniques. The proposed research and training are a crucial to move my research forward from defining gender disparities towards research aimed at understanding the causes of these disparities. Although studies have implicated provider bias as the cause of gender disparities in CVD care, to our knowledge, no study has directly measured such attitudes using validated instruments. Tools have been developed in other fields that measure implicit (unconscious) gender attitudes such as the Implicit Association Test (IAT). These tools have been widely used to explain gender differences in social outcomes including job promotions and performance evaluations, but they have not been widely applied to the study of health care disparities. Furthermore, these tools may need to be adapted to capture concepts specific to CVD care, such as a provider's belief about women's willingness to undergo invasive procedures or whether a provider views women as fragile and therefore more likely to have a complication from an invasive procedure. This gap in knowledge is a barrier to developing evidence-based interventions to address gender disparities. The research objectives of this Career Development Award are to adapt existing measures of gender attitudes to apply to decisions concerning the use of invasive CVD procedures and to conduct preliminary tests of these adapted measures. The research will occur in three steps. For aim 1, I will conduct semi-structured interviews with cardiologists, using two case scenarios in which an invasive cardiac procedure might be recommended. These interviews will be used to determine providers' gender attitudes specific to invasive cardiac procedures, and the results will then be used to adapt existing measures of gender attitudes. Next, in aim 2, I will test the adapted measures within a second cohort of cardiologists to determine the relationship between measured attitudes and the providers' decision to use an invasive cardiac procedure with women and men in the standard case scenarios. Finally, in aim 3, I will conduct a study to test my ability to link the adapted measures results and the subject cardiologists' actual clinical decisions obtained from retrospective clinical data. As a health services researcher, woman and practicing cardiologist, I am uniquely positioned to make important contributions to the field of gender disparities and CVD. I will bridge the fields of social psychology and health services research in order to gain a better understanding of potential contributors to gender disparities and plan for multimodal interventions aimed at reducing or eliminating disparities in CVD care. My extensive methodological training, research experience and proposed training activities make me ideally positioned to perform the proposed studies. Furthermore, the unique resources available at the University of Colorado Denver and its affiliated campuses will ensure my success towards these goals. Specifically, my mentorship team includes experts in health services and disparities research (Drs. Masoudi, Havranek, and Blair), measurement of explicit and implicit bias using social psychology experimental procedures (Dr. Blair), adaption of survey tools based on qualitative techniques (Dr. Main) and advanced hierarchical modeling (Dr. Dickinson). This qualified group of mentors and the training activities I propose will ensure my successful transition towards independence.

项目概要/摘要 我的长期职业目标是成为全国公认的心血管疾病 (CVD) 差异方面的独立研究者和专家，重点是旨在消除差异的干预措施。通过建立广泛的指导网络、获得卫生服务研究方面的正式培训以及领导多个研究项目，我为实现这一目标奠定了坚实的基础。迄今为止，我的研究主要集中在描述心血管疾病护理中的性别差异。例如，我已经证明患有 CVD 的女性比患有 CVD 的男性接受的侵入性手术更少。尽管有大量研究记录了这些差异，但很少有人调查其原因。我致力于通过开展旨在了解性别差异背后机制的研究来解决这一差距，以实现我的最终目标，即采取基于证据的干预措施来减少心血管疾病护理中的性别差异。 医学研究所已确定提供者偏见是造成医疗保健差异的一个关键因素。然而，关于使用侵入性 CVD 手术的基于性别的决策中，提供者偏见的作用尚不清楚。为了更准确、更全面地衡量提供者的态度，必须采用先进的定性和社会心理学技术；我希望发展的技能。因此，我寻求职业发展奖，以便让我有时间和支持进行指导性研究，旨在衡量提供者的性别态度以及定性研究、社会心理学和先进生物统计技术领域的培训。拟议的研究和培训对于推动我的研究从定义性别差异转向旨在了解这些差异原因的研究至关重要。 尽管研究表明医疗服务提供者的偏见是造成 CVD 护理中性别差异的原因，但据我们所知，还没有研究使用经过验证的仪器直接测量这种态度。其他领域也开发了测量内隐（无意识）性别态度的工具，例如内隐联想测试（IAT）。这些工具已被广泛用于解释社会结果中的性别差异，包括职位晋升和绩效评估，但尚未广泛应用于医疗保健差异的研究。此外，这些工具可能需要进行调整，以捕获特定于 CVD 护理的概念，例如提供者对女性愿意接受侵入性手术的看法，或者提供者是否认为女性脆弱，因此更有可能因侵入性手术而出现并发症。这种知识差距是制定基于证据的干预措施来解决性别差异的障碍。 该职业发展奖的研究目标是调整现有的性别态度衡量标准，以应用于有关使用侵入性心血管疾病手术的决策，并对这些调整后的衡量标准进行初步测试。研究将分三步进行。对于目标 1，我将使用可能建议进行侵入性心脏手术的两个案例场景与心脏病专家进行半结构化访谈。这些访谈将用于确定提供者对侵入性心脏手术的性别态度，然后将结果用于调整现有的性别态度衡量标准。接下来，在目标 2 中，我将在第二组心脏病专家中测试调整后的措施，以确定测量的态度与提供者在标准病例场景中对女性和男性使用侵入性心脏手术的决定之间的关系。最后，在目标 3 中，我将进行一项研究，以测试我将调整后的测量结果与受试者心脏病专家从回顾性临床数据中获得的实际临床决策联系起来的能力。 作为一名卫生服务研究员、女性和执业心脏病专家，我具有独特的优势，可以为性别差异和心血管疾病领域做出重要贡献。我将在社会心理学和健康服务研究领域之间架起桥梁，以便更好地了解性别差异的潜在因素，并计划旨在减少或消除心血管疾病护理差异的多模式干预措施。我广泛的方法培训、研究经验和拟议的培训活动使我处于执行拟议研究的理想位置。此外，科罗拉多大学丹佛分校及其附属校园提供的独特资源将确保我成功实现这些目标。具体来说，我的导师团队包括卫生服务和差异研究方面的专家（Masoudi 博士、Havranek 和 Blair）、使用社会心理学实验程序测量显性和隐性偏见（Blair 博士）、基于定性技术的调查工具的调整（ Main 博士）和高级分层建模（Dickinson 博士）。这群合格的导师和我提议的培训活动将确保我成功过渡到独立。