Improving Clinical Encounter Communications to Enhance Minority Diabetes Care

DESCRIPTION provided by applicant Disparities in healthcare delivery and outcomes have been linked in part to the difficulties physicians have in establishing effective communication with patients who differ from themselves in terms of race ethnicity and economic circumstances Type diabetes mellitus and pre diabetic nutrition based obesity are an important case in point Racial and socio economic differences can impede doctorsandapos ability to understand their patientsandapos constraining realities such as the complex tradeoffs and decision strategies involved in daily activities like purchasing food and medications When clinical encounters about diabetes diagnosis and management are not tailored to the patientandapos s pragmatic realities they become less likely to lead to a shared understanding of what needs to be done This can in turn lead physicians to perceive that minority patients are non compliant and ignoring their advice To be effective these encounter based discussions about care behavior and self care require a dialog that is adaptive to the cultural assumptions cognitive emotional concerns and systemic socio economic constraints of the individual patient This area is in need of improvement clinicians treating populations affected by health disparities must possess the competencies to understand how to frame and tailor their dialogs to the unique needs of these patients The system we envision Realizing Enhanced Patient Encounters through Aiding and Training REPEAT will provide an innovative alternative to current very minimal training It encapsulates best practices in a low cost ubiquitously accessible system based on experiential learning REPEAT will offer a realistic virtual environment that allows learning to occur through simulated interactions with synthetic standardized patients SSPs These are interactive computer generated avatars that can act and react realistically via verbal and via nonverbal to clinician communications during an office visit Emerging cognitive simulation technology will imbue the SSPs with attributes e g environmental and economic limitations beliefs attitudes fears that are representative of shared characteristics of a specific patient subpopulation Phase I built a preliminary REPEAT prototype as a limited set of virtual clinical encounters and experimentally assessed it using a sample of graduating medical students The assessment showed significant improvement in communication performance using multiple measures after only a few hours of practice in REPEAT virtual encounters as guided by REPEATandapos s proactive coaching reactive feedback and other forms of tutoring Phase II will develop a full curriculum to teach knowledge and skills needed to engage low income African Americans with T D or pre diabetic obesity and productively adapt treatment plans to the socio economic barriers they face Phase II will also develop commercializable software tools to create and deliver this and other REPEAT curricula The technology has the potential to be translated to broad usage including a version usable by patients and to reduce healthcare disparities by improving communication among providers and patients PUBLIC HEALTH RELEVANCE This research will address health disparities in diabetes care and outcomes by improving the provider patient communication process The REPEAT Realizing Enhanced Patient Encounters through Aiding and Training system is a low cost highly scalable learning technology that provides open ended tailored practice feedback opportunities using synthetic standardized patients SSPs Through it clinicians can learn crucial cultural competence interpersonal and communication skills REPEAT has high potential to dramatically improve clinical communication and diabetes management and reduce complications in low income African American populations