The Impacts of Adverse Provider Conditions on Provider Bias and Health Disparities - PROJECT SUMMARY Healthcare inconsistencies that adversely affect patients from specific social groups are often attributed to provider level factors. One potential contributing factor to inconsistent patient care is that some situations (e.g., stress, burnout, illness) reduce healthcare providers’ abilities to make objective and uniform clinical decisions. However, efforts to reduce treatment inconsistencies have been hindered by an incomplete knowledge of situations that contribute to compromised decision-making. This proposal will address this critical knowledge gap by identifying situations that negatively affect clinical decision-making among healthcare providers that can be intervened on at the provider and system level. The proposed research leverages theory from psychology and psychoneuroimmunology to document the impact of three adverse provider conditions (APCs) that could lead to inconsistent patient care decisions: (1) workplace demands (e.g., heightened levels of stress or burnout), (2) concerns about one’s own health, and (3) increased inflammation occurring during illness. We hypothesize that when providers experience higher (versus lower) workplace demands, are more (versus less) concerned about their own health, and experience higher (versus lower) acute inflammation, they will demonstrate more patient care inconsistencies. We will test our hypothesis in the context of abdominal pain treatment in emergency departments. Participants will be attending physicians, nurse practitioners, physician’s assistants, and residents in emergency medicine and internal medicine hospitalists who treat abdominal pain for patients who are admitted. We will address three specific aims to document effects of APCs on inconsistent quality of care. To address Aim 1, we will use a correlational design to determine the relationship between APCs and standardized assessments of decision-making. To address Aim 2, we will use a randomized controlled intervention design; we will simulate illness by experimentally increasing inflammation (indexed by pro-inflammatory cytokine levels). Increases in cytokines are hypothesized to be positively associated with standardized assessments of decision-making. To address Aim 3, we will use a prospective, longitudinal design to track provider illness symptoms, stress, burnout, and local cases of infectious illness over the course of a year. These provider data will be correlated with patient data from abdominal pain cases treated by the provider on those days. This study has high ecological validity and findings will identify distinct contributions of APCs to inconsistencies in quality of care among different groups. Overall, the proposed research will have widespread positive impact by outlining paths for novel interventions at multiple levels and domains of influence within the NIMHD Research Framework, such as by engaging administrators and clinical management stakeholders in conversations about consequences of staffing policies for healthcare inconstancies.
