Topaz Maxim, Song Jiyoun, Davoudi Anahita, McDonald Margaret, Taylor Jacquelyn, Sittig Scott, Bowles Kathryn
Columbia University School of Nursing, New York, NY, United States.
Data Science Institute, Columbia University, New York, NY, United States.
JMIR Nurs. 2023 Apr 17;6:e42552. doi: 10.2196/42552.
A clinician's biased behavior toward patients can affect the quality of care. Recent literature reviews report on widespread implicit biases among clinicians. Although emerging studies in hospital settings show racial biases in the language used in clinical documentation within electronic health records, no studies have yet investigated the extent of judgment language in home health care.
We aimed to examine racial differences in judgment language use and the relationship between judgment language use and the amount of time clinicians spent on home visits as a reflection of care quality in home health care.
This study is a retrospective observational cohort study. Study data were extracted from a large urban home health care organization in the Northeastern United States. Study data set included patients (N=45,384) who received home health care services between January 1 and December 31, 2019. The study applied a natural language processing algorithm to automatically detect the language of judgment in clinical notes.
The use of judgment language was observed in 38% (n=17,141) of the patients. The highest use of judgment language was found in Hispanic (7,167/66,282, 10.8% of all clinical notes), followed by Black (7,010/65,628, 10.7%), White (10,206/107,626, 9.5%), and Asian (1,756/22,548, 7.8%) patients. Black and Hispanic patients were 14% more likely to have notes with judgment language than White patients. The length of a home health care visit was reduced by 21 minutes when judgment language was used.
Racial differences were identified in judgment language use. When judgment language is used, clinicians spend less time at patients' homes. Because the language clinicians use in documentation is associated with the time spent providing care, further research is needed to study the impact of using judgment language on quality of home health care. Policy, education, and clinical practice improvements are needed to address the biases behind judgment language.
临床医生对患者的偏见行为会影响医疗质量。近期的文献综述报道了临床医生中普遍存在的隐性偏见。尽管医院环境中的新兴研究显示电子健康记录中临床文档所使用的语言存在种族偏见，但尚无研究调查家庭医疗保健中判断性语言的程度。
我们旨在研究判断性语言使用中的种族差异，以及判断性语言使用与临床医生进行家访所花费时间之间的关系，以此反映家庭医疗保健的质量。
本研究为回顾性观察队列研究。研究数据取自美国东北部一家大型城市家庭医疗保健机构。研究数据集包括2019年1月1日至12月31日期间接受家庭医疗保健服务的患者（N = 45,384）。该研究应用自然语言处理算法自动检测临床记录中的判断性语言。
在38%（n = 17,141）的患者中观察到了判断性语言的使用。判断性语言使用比例最高的是西班牙裔患者（7,167/66,282，占所有临床记录的10.8%），其次是黑人患者（7,010/65,628，占10.7%）、白人患者（10,206/107,626，占9.5%）和亚裔患者（1,756/22,548，占7.8%）。与白人患者相比，黑人和西班牙裔患者的临床记录出现判断性语言的可能性要高14%。使用判断性语言时，家庭医疗保健访视时长减少了21分钟。
研究发现了判断性语言使用中的种族差异。使用判断性语言时，临床医生在患者家中花费的时间会减少。由于临床医生在文档中使用的语言与提供护理所花费的时间相关，因此需要进一步研究使用判断性语言对家庭医疗保健质量的影响。需要通过政策、教育和临床实践改进来解决判断性语言背后的偏见问题。
