Measuring Cultural Competence and Racial Bias Among Physicians

衡量医生的文化能力和种族偏见

• 批准号: 7243188
• 负责人: SOMNATH SAHA
• 金额: $ 18.9万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-04-01 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7243188
• 关键词: Address; Adherence; African American; American; Anxiety; Applications Grants; Attitude; Belief; Caring; Clinical; Cognitive; Communication; Competence; Complex; Decision Making; Development; Dimensions; Education; Educational process of instructing; Effectiveness; Effectiveness of Interventions; Ethnic group; Evaluation; Face; Factor Analysis; Future; Goals; Health; Health Personnel; Healthcare; Institute of Medicine (U.S.); Intervention; Interview; Knowledge; Latino; Measures; Medical; Minority; Minority Groups; Modeling; Nature; Outcome; Patient Care; Patients; Physician' s Role; Physician-Patient Relations; Physicians; Play; Psychologist; Psychometrics; Quality of Care; Range; Reliability of Results; Reporting; Research; Role; Sampling; Source; Stereotyping; Surveys; Testing; Training; Training Programs; Unconscious Personality Factor; Unconscious State; United States National Institutes of Health; Validity and Reliability; Variant; computerized; concept; health care quality; instrument; novel; patient oriented; programs; racial and ethnic; racial and ethnic disparities; skills; social; sound; tool

DESCRIPTION (provided by applicant): Emerging evidence suggests that racial barriers in the patient-physician relationship may be an important source of disparities in the quality of health care. These barriers include cultural dissimilarity between doctors and patients; social discomfort or distrust when interacting with people from other racial or ethnic groups ("interracial anxiety"); and negative racial bias or stereotyping of minority patients by physicians. Training in "cultural competence" has become the primary vehicle for reducing the impact of racial barriers betweens patients and physicians. To date, however, there has been limited empirical evidence to inform the content of cultural competence training. Specifically, there has been scant research on the nature and influence of specific racial barriers in the patient-physician relationship, and on the knowledge, attitudes, and skills needed to reduce them. The objective of this developmental grant application is to develop and test tools necessary to measure racial barriers and cultural competence in the patient-physician relationship, as a first step towards assessing their role in causing and mitigating, respectively, racial disparities in health care quality and outcomes. Our specific aims are to: 1) develop a psychometrically sound instrument measuring cultural competence among physicians; 2) test the reliability and validity of scales measuring interracial anxiety among physicians; and 3) test the validity of a computerized, interactive tool measuring racial bias among physicians. We will use a multi-step approach to achieve these aims, including expert scientific review of draft survey items, cognitive interviews with practicing physicians, a national physician survey, and psychometric analysis. Developing and testing measures of cultural competence and racial barriers in the patient-physician relationship will provide essential tools necessary to advance the study of racial disparities in health care. These measures will serve at least three crucial functions. First, they will allow us to empirically assess the role of physician bias, and other racial barriers in the patient-physician relationship, in explaining disparities in the quality of health care. Second, they will allow us to determine which (if any) facets of the broad concept of cultural competence reduce racial barriers and in turn reduce health care disparities. Both of these steps will help inform the content of cultural competence training and other interventions to reduce disparities. Finally, rigorously developed measures of racial barriers and cultural competence will provide needed evaluation tools for judging the effectiveness of cultural competence programs, many of which are currently being developed under NIH sponsorship. The aims of this project are to develop and test tools needed to explore the role of racial barriers in the patient- physician relationship as a source of disparities in the quality of health care, and the role of cultural competence among physicians as a means to mitigate those barriers. These tools are needed to inform and evaluate future interventions to reduce pervasive racial disparities in health care quality and outcomes.

描述（由申请人提供）：新出现的证据表明，医患关系中的种族障碍可能是医疗保健质量差异的重要根源。这些障碍包括医生和患者之间的文化差异；与其他种族或族裔群体的人互动时出现社交不适或不信任（“种族焦虑”）；医生对少数族裔患者的负面种族偏见或成见。 “文化能力”培训已成为减少患者和医生之间种族障碍影响的主要手段。然而，迄今为止，关于文化能力培训内容的经验证据还很有限。具体来说，关于医患关系中特定种族障碍的性质和影响，以及减少这些障碍所需的知识、态度和技能的研究还很少。这项发展拨款申请的目的是开发和测试必要的工具，以衡量医患关系中的种族障碍和文化能力，作为评估它们分别在造成和减轻医疗保健质量和种族差异方面的作用的第一步。结果。我们的具体目标是：1）开发一种心理测量学上合理的工具来衡量医生的文化能力； 2）测试医生测量种族焦虑的量表的信度和效度； 3）测试测量医生种族偏见的计算机化交互式工具的有效性。我们将采用多步骤方法来实现这些目标，包括专家对调查项目草案的科学审查、对执业医生的认知访谈、全国医生调查和心理测量分析。制定和测试医患关系中的文化能力和种族障碍的衡量标准将为推进医疗保健中种族差异的研究提供必要的工具。这些措施将至少发挥三个关键作用。首先，它们将使我们能够凭经验评估医生偏见和医患关系中的其他种族障碍在解释医疗保健质量差异方面的作用。其次，它们将使我们能够确定文化能力这一广泛概念的哪些（如果有的话）方面可以减少种族障碍，进而减少医疗保健差异。这两个步骤都将有助于了解文化能力培训和其他干预措施的内容，以减少差异。最后，严格制定的种族障碍和文化能力衡量标准将为判断文化能力项目的有效性提供所需的评估工具，其中许多项目目前正在 NIH 的赞助下开发。该项目的目的是开发和测试所需的工具，以探索医患关系中种族障碍作为医疗保健质量差异根源的作用，以及医生文化能力作为缓解医疗保健质量差异的手段的作用。那些障碍。需要这些工具来告知和评估未来的干预措施，以减少医疗保健质量和结果方面普遍存在的种族差异。