Transcript Slide 1

Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
What is “Heads Up?”
• 2007 AAPA Committee on Diversity Project
• 90 days in University of Washington Shuttles
• 3 signs, each up on 5 buses for one month
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
What is Heads Up?
Initial Project Goals:
1. Engage Clinicians and Clinicians in Training
2. Spotlight Racial Health Disparities
3. Create focus on Implicit Bias/Stereotyping
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
What is Heads Up?
• Transitioned now to CME module
• Creation of PA School Curriculum Module
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Define “Racial Health Disparities”
Even with the same access to care, racial and
ethnic minorities receive poorer care than
white patients
(IOM’s “Unequal Treatment,” 2003)
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
IOM’s 2003 Unequal Treatment
Landmark review of data, indicating consistent disparities in care:
“Racial and ethnic minorities tend to receive a lower
quality of health care than non-minorities, even when
access-related factors, such as patient's insurance
status and income, are controlled."
Unequal Treatment, page 1
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Disparities in Cardiovascular Care
• African Americans 28% more likely to die than white Americans
from cardiovascular disease, yet African Americans referred less
frequently for cardiac catheterization
• Whites being treated in emergency rooms for chest pain more
likely to receive cardiac catheterization than African Americans
• Likelihood of having hospital-based cardiac procedures
consistently greater for whites than for African Americans
http://www.aapa.org/clinissues/disparitiestables.html#table1
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Disparities in Cardiovascular Care
• Likelihood of having cardiac procedure nearly three times
greater for whites than for African Americans
• African Americans and Hispanics received less-frequent coronary
artery bypass grafts than whites with similar diagnoses
• Fewer non-whites underwent cardiac catheterization when
meeting initiation criteria
http://www.aapa.org/clinissues/disparitiestables.html#table1
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Disparities in Cardiovascular Care
• In patients with acute myocardial infarction, African Americans
less likely than whites to receive thrombolytic therapy, coronary
arteriography and coronary artery bypass surgery
• In patients discharged from hospital stays after definite or
possible myocardial infarctions, Mexican Americans received
significantly fewer medications than whites
http://www.aapa.org/clinissues/disparitiestables.html#table1
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Racial Disparities in
Treatment of Pain
• racial and ethnic disparities in pain perception,
assessment found in all settings
• postoperative, emergency room, across all types of
pain (acute, cancer, chronic nonmalignant)
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Racial Disparities in
Treatment of Pain
• Disparities persist after controlling for
comorbidities, insurance status, treatment,
patient preferences, and access to care
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
“Implicit Bias” and
“Unconscious Stereotyping”
Research indicates:
• Implicit biases are pervasive.
• People are often unaware of their implicit
biases
• Ordinary people harbor negative associations
in relation to various groups
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
“Implicit Bias” and
“Unconscious Stereotyping”
• Implicit biases predict behavior
• People differ in levels of implicit bias
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Implicit Association Test (IAT)
• “Project Implicit”: network of laboratories,
technicians, and research scientists at Harvard
University, the University of Washington, and the
University of Virginia
• Initially launched as a demonstration website in 1998
at Yale University, and began to function fully as a
research enterprise following a grant from the
National Institute of Mental Health in 2003
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Implicit Association Test (IAT)
• Series of online assessments related to
multilple groups (sexual orientation, race,
gender, religion)
• Feedback and assessment results immediate
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Implicit Bias and Clinical Outcomes
• Physicians reported no explicit preference for
white versus black patients
• Implicit Association Test (IAT) revealed
implicit preference favoring white Americans
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Implicit Bias and Clinical Outcomes
• IAT revealed implicit stereotypes of black Americans
as less cooperative with medical procedures and less
cooperative generally
• As physicians’ pro-white implicit bias increased, so
did their likelihood of treating white patients and not
treating black patients with thrombolysis
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Dual Process Stereotyping
Two distinct methods of stereotyping:
1.
Automatic stereotyping
2. Goal modified stereotyping
Burgess and van Ryn: Understanding the provider contribution to
race/ethnicity disparities in pain treatment; Pain Med. 2006
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Automatic Stereotyping
• occurs when stereotypes are automatically activated
and influence judgments/behaviors outside of
consciousness
• Occur regardless of their relevance to the perceivers’
goals
Burgess and van Ryn: Understanding the provider contribution to
race/ethnicity disparities in pain treatment; Pain Med. 2006
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Goal Modified Stereotyping
• More conscious process, done when specific
needs of clinician arise (time constraints,
filling in gaps in information needed to make
complex decisions
Burgess and van Ryn: Understanding the provider contribution to
race/ethnicity disparities in pain treatment; Pain Med. 2006
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Function of Stereotyping
• Providers are likely to apply information contained in
racial/ethnic stereotypes to interpret symptoms and make
decisions
• Stereotypes likely to be used when stereotypic information is
perceived as clinically relevant, and the decision is complex
Burgess and van Ryn: Understanding the provider contribution to
race/ethnicity disparities in pain treatment; Pain Med. 2006
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Healthy People 2010
Goal II:
“… to eliminate health disparities among segments
of the population, including differences that occur
by gender, race or ethnicity, education or income,
disability, geographic location, or sexual
orientation.”
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
HP 2010 Review in 2006:
• Substantial disparities between population groups
• Few changes in disparity since the baseline when
measured
• Overall, no consistent pattern of change in disparity
for any population group (except males)
http://www.cdc.gov/nchs/ppt/duc2006/hallquist_52.ppt#769,1,Midcourse Assessment
of Healthy People 2010 Goal II
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Creating Equity Reports
• tool that allows a clinic/site of care to examine,
measure, and address inequalities in the care
provided to patients from different cultural
backgrounds.
• it can help identify areas where things are going well
and those where there are opportunities for
improvement
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Creating Equity Reports
• can also help with monitoring progress over time
toward eliminating inequalities
• Promotes goal of providing the highest quality of care
to all patients, regardless of their race, ethnicity,
language, or socioeconomic status, or sexual
orientation
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Creating Equity Reports
STEPS:
• pick a process (examples: mammograms, guideline
adherence for asthma or diabetes)
• collect data ( who gets them, who doesn’t)
• compare racial and other cultural groups
• assess disparities, create action plan where disparity
noted
http://www.massgeneral.org/disparitiessolutions/resources.html
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Web and Other Resources
Implicit Association Test:
https://implicit.harvard.edu/implicit/
Project Implicit Information Page:
http://projectimplicit.net/
(Recommended Tests: Race, Arab-Muslim, Gender, Sexuality)
"The Police Officer's Dilemma"
http://home.uchicago.edu/~jcorrell/TPOD.html
and then click on the very bottom link
http://backhand.uchicago.edu/Center/ShooterEffect/
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
http://backhand.uchicago.edu/Center/ShooterEffect/
Heads Up!
A Project of the American Academy of Physician Assistants and the Physician Assistant Foundation
Web and Other Resources
“Heads Up!” Website:
http://www.stop-disparities.org/RESOURCES.html