Opening the Black Box of Cultural Competence

打开文化能力的黑匣子

基本信息

批准号：
8982128
负责人：
SOMNATH SAHA
金额：
--
依托单位：
PORTLAND VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-01 至 2021-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8982128
关键词：
AIDS/HIV problem AIDS/HIV problem Address Address Adopted Adopted African American African American American American Attention Attention Attitude Attitude Audiotape Audiotape Behavior Behavior Boxing Caring Caring Clinic Clinic Clinical Clinical Code Code Communication Communication Coupled Coupled Data Data Analyses Diabetes Mellitus Diabetes Mellitus Dimensions Dimensions Goals Goals Health Occupations Health Occupations Health Personnel Health Personnel Health Professional Health Professional Health Services Healthcare Healthcare Intervention Intervention Interview Interview Maps Maps Measures Measures Medical Medical Medical Care Team Medical Care Team Medical center Medical center Methods Methods Minority Minority Minority Groups Outcome Outcome Patient Care Patient Care Patient Self-Report Patient Self-Report Patient-Centered Care Patient-Centered Care Patients Patients Perception Perception Phase Phase Primary Health Care Primary Health Care Process Process Professional Organizations Professional Organizations Provider Provider Quality of Care Quality of Care Race Race Reaction Reaction Recruitment Activity Reporting Reporting Research Research Resources Resources Sampling Sampling Schools Schools Self Management Self Management Series Series Shapes Shapes Side Side Societies Source Source Surveys Surveys Testing Testing Time Time Training Training Training Programs Training Programs Transcript Transcript Variant Variant Veterans Veterans Visit Visit Work Work base base care outcomes care providers communication behavior communication behavior cultural competence cultural competence diabetic patient diabetic patient disparity reduction effective intervention effective intervention ethnic difference ethnic minority population glycemic control glycemic control health care delivery health care delivery health care disparity health care quality health care quality health care service health care service organization health care service organization health training health training improved improved instrument instrument member member patient population patient population patient response patient subsets patient-clinician communication programs programs racial and ethnic racial disparity racial disparity racial health disparity racial minority racial/ethnic difference recruit response skills skills systematic review systematic review uptake uptake

项目摘要

DESCRIPTION (provided by applicant): Racial and ethnic minority Americans receive lower quality health care than non-minorities in the U.S. These disparities are evident across a wide range of health care services, including the care of diabetes mellitus. Cultural competence (CC) training has become the principal vehicle adopted by the health professions to address healthcare disparities. CC has been widely endorsed and deployed in the U.S., but there is little consistency to what is offered in CC programs and little evidence that CC training as currently delivered is improving health care quality or equity as intended. Given the substantial resources and time being devoted to CC training, it is critical that CC programs are informed by evidence about what will improve the ability of providers and healthcare teams to deliver high-quality care equitably, across diverse patient populations. This project builds on prior work that: 1) defined CC among health professionals by producing a conceptual map of CC dimensions from a systematic review of conceptual frameworks; 2) used that conceptual map to develop an instrument measuring CC among primary care providers (PCPs); and 3) demonstrated that CC, as measured by the instrument, was associated with higher quality care for African American patients, and reduced racial disparity. This project will extend the study of CC beyond PCPs to include other Patient Aligned Care Team (PACT) members, and attempt to discern why higher CC is associated with more equitable care, specifically, what high CC providers are doing differently in their clinical encounters that results in higher quality care for African American patients. The aims of the study are to: 1. Understand differences in patient-provider communication among high and low CC primary care providers. 2. Understand patients' perceptions of their interactions and relationships with high and low CC providers/PACTs. 3. Understand the contribution of CC among providers/PACTs to quality and equity of diabetes care. These aims will be addressed using a mixed-methods approach that will include quantitative and qualitative analysis of communication behaviors observed in audiotaped clinical encounters, coupled with quantitative surveys and qualitative interviews of patients about their perceptions of the encounters and their relationships with their PCPs and PACT members. The study will be conducted in 4 VA Medical Centers. A target sample of 50 PCPs will be recruited, 25 high and 25 low on self-assessed CC. PACT teamlet members working with these PCPs will be recruited. Patients with diabetes from each PCP's primary care panel will be recruited, with a target of 5 African American and 5 white patients per PCP. Patients' visits to their PCPs will be audio- recorded and the dialogue then coded for communication content using validated communication coding systems that evaluate different types of communication behaviors. Differences in communication by provider CC will be analyzed. We will also evaluate associations between PCP/PACT CC and other outcomes, including the quality of interpersonal care, patients' perceptions of PCP/PACT CC, diabetes understanding and self-management, and glycemic control. A subsample of patients from PCPs in the top and bottom CC quintiles will be interviewed, with a goal of 1 African American and 1 white patient for each of these PCPs. Patients will listen to their audiotaped clinical encounters and offer perspectives on the interaction and their relationships with the PCP. For these patients, transcripts from both the interview and from the audio-recorded clinical encounter will be qualitatively analyzed, side-by-side. The mixed-methods approach is intended to provide both breadth and depth in understanding how provider CC manifests in clinical interactions with patients and contributes to disparities in healthcare quality and outcomes. Understanding how provider CC manifests will inform interventions that are more likely to be effective in reducing disparities, because they will be based on empirical evidence of how providers who deliver more equitable care interact with patients.

描述（由申请人提供）：在美国，少数族裔和少数族裔美国人获得的医疗保健质量低于非少数族裔。这些差异在各种医疗保健服务中都很明显，包括糖尿病护理。文化能力 (CC) 培训已成为美国采用的主要手段。 CC 在美国得到了广泛认可和部署，但 CC 项目提供的内容缺乏一致性，也没有证据表明目前提供的 CC 培训能够改善医疗保健质量或公平性。鉴于 CC 培训投入了大量资源和时间，CC 计划必须了解如何提高提供者和医疗团队在不同患者群体中公平提供高质量护理的能力。建立在先前工作的基础上：1) 通过对概念框架的系统审查生成 CC 维度的概念图来定义卫生专业人员的 CC；2) 使用该概念图开发衡量初级保健提供者 (PCP) 中的 CC 的工具； 3) 证明了 CC，通过测量该项目与非裔美国患者的更高质量护理相关，并减少了种族差异。该项目将把 CC 的研究扩展到 PCP 之外，包括其他患者协调护理团队 (PACT) 成员，并试图找出为什么更高的 CC 相关。提供更公平的护理，特别是高 CC 提供者在临床中采取的不同做法，从而为非裔美国患者提供更高质量的护理。该研究的目的是： 1. 了解高和低提供者之间患者与提供者沟通的差异。 CC 初级保健提供者。 2. 了解患者对其与高和低 CC 提供者/PACT 的互动和关系的看法 3. 了解提供者/PACT 之间的 CC 对糖尿病护理质量和公平性的贡献这些目标将使用混合方法来实现。该研究将包括对临床就诊录音中观察到的沟通行为进行定量和定性分析，并对患者进行调查和定性访谈，了解患者对就诊的定量看法以及他们与 PCP 和 PACT 成员的关系。该研究将在 4 VA Medical 进行。将招募 50 名 PCP 目标样本，其中将从每个 PCP 的初级保健小组中招募 25 名高水平和 25 名低水平的自我评估 CC 成员。每位 PCP 的 5 名非裔美国人和 5 名白人患者的访问将被录音，然后使用经过验证的通信编码系统对对话进行编码，以评估不同类型的通信。我们还将分析提供者 CC 的沟通差异，以及 PCP/PACT CC 与其他结果之间的关联，包括人际护理质量、患者对 PCP/PACT CC 的看法、糖尿病理解和自我管理。将对来自 CC 顶部和底部五分位数的 PCP 患者的子样本进行访谈，目标是每个 PCP 中有 1 名非裔美国人和 1 名白人患者，患者将听取他们的临床经历录音带。对于这些患者的互动及其与 PCP 的关系，将同时对访谈记录和录音临床经历进行定性分析。混合方法旨在提供这两种方法。广度和深度地了解提供者 CC 在与患者的临床互动中如何表现以及如何导致医疗质量和结果的差异了解提供者 CC 如何表现将为更有可能有效减少差异的干预措施提供信息，因为它们将基于经验。提供者如何提供证据他们与患者提供更公平的护理互动。