Counter Bias Training Simulation (CBTsim) Healthcare: A Novel Approach for Reducing the Impact of Implicit Bias on Healthcare Delivery

反偏见培训模拟 (CBTsim) 医疗保健：减少隐性偏见对医疗保健服务影响的新方法

• 批准号: 10637978
• 负责人: Lois James
• 金额: $ 44.62万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-22 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10637978
• 关键词: Address; Affect; African American population; Analgesics; Attitude; Awareness; Belief; Care given by nurses; Centers for Disease Control and Prevention (U.S.); Cessation of life; Client satisfaction; Communication; Complex; Conscious; Control Groups; Decision Making; Development; Discipline of Nursing; Disparity; Effectiveness; Ethnic Origin; Gender; Health; Health Professional; Healthcare; Homelessness; Hospitals; Hour; Human; Implicit Association Test; Inequality; Inequity; Intervention; Learning; Lesbian Gay Bisexual Transgender Queer; Manikins; Measures; Medical center; Methods; Military Personnel; Nurses; Outcome; Patient Care; Patients; Performance; Persons; Pharmaceutical Preparations; Police; Police officer; Prejudice; Public Health; Questionnaires; Race; Randomized, Controlled Trials; Recommendation; Research; Review Literature; Social Justice; Socioeconomic Status; Testing; Therapeutic; Training; Training Programs; Unconscious State; United States Agency for Healthcare Research and Quality; United States National Institutes of Health; Universities; Washington; addiction; care outcomes; college; design; disability; economic impact; effectiveness testing; experience; explicit bias; healing; health care delivery; health care disparity; health disparity; implicit bias; innovation; lectures; medication administration; member; minority health disparity; minority healthcare; novel; novel strategies; post intervention; programs; racial bias; simulation; skills; social group; treatment group; unconscious bias; virtual experiments

ABSTRACT Bias in how clinicians form relationships with and treat patients exists based on patient race, ethnicity, gender, socio-economic status, LGBTQ+ status, disability, addiction and other factors. Implicit or unconscious biases (the ways in which our beliefs, attitudes, and values influence how we see the world and the people in it) are widespread and affect patients’ health outcomes. Our team has developed Counter Bias Training Simulation (CBTsim), an innovative and unique training program that uses simulation to reduce the impact of implicit bias on how people interact and make decisions that affect others. Versions have been developed for policing and military professionals to enhance their ability to interact with diverse groups of citizens in unbiased ways. CBTsim has great relevance to healthcare, for which existing bias trainings are typically video or lecture based, and may be ineffective at reducing the impact of bias on patient-clinician relationships (PCR) and consequent healthcare delivery. The purpose of this study is to develop “CBTsim Healthcare” and evaluate its effectiveness at reducing bias in how nurses treat their patients. The proposed study will be jointly conducted in the Washington State University College of Nursing Simulation Lab and Providence Medical Center in Spokane. First, we will develop CBTsim Healthcare scenarios based on an extensive review of the literature on healthcare disparities. Then, we will conduct a randomized control trial with 100 nurses to test the effectiveness of CBTsim Healthcare. Nurses will receive 2 hours of baseline testing, then 50 (treatment group) will receive a 4-hour CBTsim Healthcare training and the other 50 (control group) will watch a 1-hour video on implicit bias in healthcare, typical of current standard practice. Then, all 100 nurses will receive 2 hours of post-intervention testing. Testing will include the implicit association test (IAT) to measure implicit bias, questionnaires to measure prejudice, and patient care scenarios using simulation mannequins to test for bias in PCR and other aspects of healthcare delivery. Finally, we will track treatment and control group nurses in the hospital for 6 months following the intervention to assess disparities in healthcare, measured using patient satisfaction with nursing care scales (quantitative measure) and narratives to document experience of PCR (qualitative measure). All major health agencies have identified reduction of implicit bias in healthcare and resulting minority health disparities as a matter of extreme importance and urgency. The economic impact of health disparities is an estimated $230 billion a year, and the social justice impact is immeasurable. Our current focus on nurses is due to our existing relationship (e.g., on AHRQ R01 HS025965-01), however we anticipate that CBTsim Healthcare could be modified for other healthcare professional groups and could have a revolutionary impact on reducing bias in healthcare delivery nationwide.

抽象的 根据患者种族，种族，临床医生如何与患者建立关系和治疗患者的关系的偏见， 性别，社会经济地位，LGBTQ+状态，残疾，成瘾和其他因素。隐式或 无意识的偏见（我们的信念，参加和价值观的方式影响着我们如何看待世界 而且其中的人是广泛的，并影响患者的健康成果。我们的团队已经开发了计数器 偏见培训模拟（CBTSIM），这是一种创新且独特的培训计划，使用模拟来 减少隐性偏见对人们如何互动并做出影响他人的决策的影响。版本 已经为政策和军事专业人士开发了与潜水者互动的能力 一群公民以公正的方式。 CBTSIM与医疗保健有很大的相关性，现有的偏见 培训通常是基于视频或讲座的，并且可能无效地减少偏见的影响 患者 - 临床医生关系（PCR）和随之而来的医疗保健提供。这项研究的目的是 开发“ CBTSIM医疗保健”，并评估其在减少护士如何对待他们的偏见方面的有效性 患者。拟议的研究将在华盛顿州立大学护理学院共同进行 斯波坎的模拟实验室和普罗维登斯医疗中心。首先，我们将开发CBTSIM医疗保健 基于对医疗保健分销文献的广泛审查的方案。然后，我们将进行 与100位护士的随机对照试验测试CBTSIM医疗保健的有效性。护士会收到 2小时的基线测试，然后50个（治疗组）将接受4小时的CBTSIM医疗保健培训和 其他50个（对照组）将观看有关医疗保健中隐性偏见的1小时视频，典型的当前 标准练习。然后，所有100位护士将接受2小时的干预后测试。测试将包括 隐式关联测试（IAT），以测量隐式偏见，测量偏见的问卷和患者 使用模拟人体模型的护理方案测试PCR和其他医疗保健的其他方面 送货。最后，我们将在医院跟踪医院的治疗和对照组护士6个月 干预措施评估医疗保健方面的差异，使用患者对护士护理量表的满意度测量 （定量测量）和记录PCR经验的叙述（定性测量）。都是专业 卫生机构已经确定了减少医疗保健中的隐性偏见，并导致少数群体健康 差距非常重要和紧迫。健康分配的经济影响是 估计每年2,300亿美元，社会正义影响是不可估量的。我们目前对护士的关注是 由于我们现有的关系（例如，在AHRQ R01 HS025965-01上），但是我们预计CBTSIM 可以为其他医疗保健专业团体修改医疗保健，并可能具有革命性 对减少全国医疗保健提供偏见的影响。