Race/Ethnic Disparities in Diabetes: An Experiment

糖尿病中的种​​族/民族差异：一项实验

• 批准号: 6821290
• 负责人: John B McKinlay
• 金额: $ 62.56万
• 依托单位: NEW ENGLAND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6821290
• 关键词: Germany; age difference; cognition; decision making; diagnosis; gender difference; health care quality; health disparity; health services research tag; human subject; medical complication; noninsulin dependent diabetes mellitus; patient care personnel attitude; racial /ethnic difference; sign /symptom; socioeconomics; statistics /biometry

DESCRIPTION (provided by applicant): Program Announcement (PA-02-165) concerning "Race/Ethnic Disparities in the Incidence of Diabetes Complications" invited research on "both biologic and non-biologic factors" and suggested that differences by race/ethnicity and socioeconomic status may be partly due to provider behavior and health care system influences. This theoretically based research builds on the experience and success of earlier studies and investigates the contribution of provider behavior and features of the health care system (both potentially modifiable) to observed disparities in the clinical management of type 2 diabetes mellitus. Novel use of an experimental (factorial) design yields unconfounded estimates of different types of patient, provider and health system contributions to recognized disparities. The project has four aims: 1) to estimate the influence of patient attributes (race/ethnicity, gender, age and SES) on clinical decision making (CDM) for two commonly presented clinical situations (undiagnosed symptoms and signs of diabetes and already diagnosed diabetes with complications); 2) to estimate the influence of physician characteristics (age/clinical experience and gender) on CDM for the presenting cases; 3) to measure the influence of features of the health care system on CDM - both within the US (practice setting, ownership and financial arrangement) and between different systems (requiring the inclusion of other systems for purposes of comparison); 4) to understand the underlying cognitive reasons for the differences in CDM that are observed. This research moves the focus of health disparities research from the behavior, biophysiology and genetic background of individuals (patients) to aspects of provider decision-making and health system influences. Profound policy implications follow from the suggestion that the elimination of health disparities should be sought as much through changes in provider behavior and the system, as through the biophysiology and health care behaviors of those at risk to diabetes and its complications.

描述（由申请人提供）：有关“糖尿病并发症发生率的种族/种族差异”的计划公告（PA-02-165）邀请了对“生物学和非生物学因素和非生物学因素”的研究，并表明种族/种族和社会经济地位的差异可能会因提供者的行为和医疗保健系统而受到部分影响。这项基于理论上的研究以早期研究的经验和成功为基础，并研究了医疗保健系统的提供者行为和特征（均可修改）对观察到的2型糖尿病临床管理中的差异的贡献。实验（阶乘设计）设计的新颖使用可产生不同类型的患者，提供者和卫生系统对公认差异的贡献的估计。 该项目具有四个目标：1）估计患者属性（种族/种族，性别，年龄和SES）对临床决策（CDM）的影响（CDM），以表现出两种常见的临床情况（糖尿病的症状和症状未诊断，并且已经被诊断出患有并发症的糖尿病）； 2）估计医师特征（年龄/临床经验和性别）对CDM的影响； 3）衡量医疗保健系统对CDM的特征的影响 - 无论是在美国范围内（实践设置，所有权和财务安排）和不同系统之间（需要为比较而包含其他系统）； 4）了解观察到的CDM差异的潜在认知原因。 这项研究将健康差异研究的重点从个人（患者）的行为，生物生理学和遗传背景转移到提供者决策和卫生系统影响的方面。深刻的政策含义得出的建议是，通过提供者行为和系统的变化，应与有糖尿病风险及其并发症的人的生物生理学和保健行为一样，消除健康差异。