Racial disparities in health care are well described. Provision of differential or inferior care to minorities is widely believed to be a major reason for the health gaps seen between White patients and minorities such as African Americans / Blacks and Hispanics. The underlying factors and mechanisms that lead to poorer quality of care for minorities have not been fully elucidated and the NIH seeks to "enhance understanding of the influence of racial discrimination in health care delivery and its association with disparities." This study seeks to test two hypotheses 1) Blacks and Hispanics receive inferior trauma care which leads to increased complications and worse long term clinical and functional outcomes and 2) Similar to the general population, trauma care providers possess an unconscious (implicit) racial bias towards Black patients which impacts clinical decision making. To test hypothesis #1, a comprehensive analysis of data collected during the NIH/CDC funded prospective, multicenter National Study on Costs and Outcomes of Trauma (NSCOT) will be conducted to determine A) The presence of racial disparities in mortality and long term functional outcomes, controlling for patient co-morbidities, insurance status and measures of socioeconomic status including median household income, education and occupation. B) Determine if minority patients (Blacks and Hispanics) in NSCOT received differential clinical treatments, diagnostic tests, major procedures or suffered more complications than White patients;and C) Determine how differences in clinical treatments, diagnostic tests, major procedures or complications lead to worse outcomes. Testing hypothesis #2 entails original data collection to assess the prevalence of unconscious racial bias among trauma surgeons and determine its potential association with clinical decision-making. For this purpose the Implicit Association Test (IAT), a valid and reliable measure of implicit bias will be administered to more than three hundred trauma surgeon members of the Eastern Association for the Surgery of Trauma (EAST) via an internet based secure survey. Through this web survey we will A) Measure the presence of unconscious racial attitudes among trauma care providers, B) Use clinical vignettes to determine if patient race impacts a trauma surgeon's clinical decision-making (i.e. do trauma surgeons treat Black or White patients differently?);and C) Correlate provider IAT scores to clinical vignette decisions in an effort to determine if implicit bias impacts clinical decision making. Conducted by an interdisciplinary team that crosses the boundaries of social psychology, emergency medicine, public health and trauma surgery this study has the potential to help us understand the underlying causes of racial disparities after trauma care. Results of this study will be used to inform the development of innovative solutions directed at effectively diminishing or eliminating health care disparities.

Public Health Relevance

This study is designed to help elucidate the factors and mechanisms that lead to racial disparities after trauma. The first part of the study will analyze care provided to thousands of severely injured trauma patients to determine if Black or Hispanic patients received differential treatments or care processes when compared to similarly injured White patients. The second part of the study will use an internet based test to determine if unconscious racial bias effects clinical decision making by trauma surgeons. This study will give us valuable information that can be used to develop innovative solutions to help diminish and potentially eliminate health care disparities.

Agency
National Institute of Health (NIH)
Institute
National Institute of General Medical Sciences (NIGMS)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23GM093112-04
Application #
8514637
Study Section
Special Emphasis Panel (ZRG1-F16-B (20))
Program Officer
Somers, Scott D
Project Start
2010-08-03
Project End
2014-07-31
Budget Start
2013-08-01
Budget End
2014-07-31
Support Year
4
Fiscal Year
2013
Total Cost
$129,010
Indirect Cost
$9,260
Name
Johns Hopkins University
Department
Surgery
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
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Schwartz, Diane A; Hui, Xuan; Schneider, Eric B et al. (2014) Worse outcomes among uninsured general surgery patients: does the need for an emergency operation explain these disparities? Surgery 156:345-51
Haider, Adil H; Figura, Ronald H; Ladha, Karim et al. (2014) Can we decrease the number of trauma patients 'missing in action'? A prospective pilot intervention to improve trauma patient compliance with outpatient follow-up at an urban Level I trauma center. Am Surg 80:96-8
Haider, Adil H; Schneider, Eric B; Sriram, N et al. (2014) Unconscious race and class bias: its association with decision making by trauma and acute care surgeons. J Trauma Acute Care Surg 77:409-16

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