Division of Pediatric Endocrinology, Department of Pediatrics, Stanford School of Medicine, California.
T1D Exchange, Boston, Massachusetts.
Endocr Pract. 2024 Jan;30(1):41-48. doi: 10.1016/j.eprac.2023.10.001. Epub 2023 Oct 6.
Medical racism contributes to adverse health outcomes. Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) is a large population-based cohort engaged in data sharing and quality improvement to drive system changes in T1D care. The annual T1DX-QI survey included questions to evaluate racial equity in diabetes care and practices to promote equity.
The annual T1DX-QI survey was administered to participating clinics in fall 2022 and had a 93% response rate. There were 50 responses (pediatric: 66% and adult: 34%). Questions, in part, evaluated clinical resources and racial equity. Response data were aggregated, summarized, and stratified by pediatric/adult institutions.
Only 21% pediatric and 35% adult institutions felt that all their team members can articulate how medical racism contributes to adverse diabetes outcomes. Pediatric institutions reported more strategies to address medical racism than adult (3.6 vs 3.1). Organizational strategies to decrease racial discrimination included employee trainings, equity offices/committees, patient resources, and hiring practices. Patient resources included interpreter services, transportation, insurance navigation, and housing and food assistance. Hiring practices included changing prior protocols, hiring from the community, and diversifying workforces. Most institutions have offered antiracism training in the last year (pediatric: 85% and adult: 72%) and annually (pediatric: 64% and adult: 56%). Pediatric teams felt that their antiracism training was effective more often (pediatric: 60% and adult: 45%) and more commonly, they were provided resources (pediatric: 67% and adult: 47%) to help address inequities.
Despite increased antiracism training, insufficient institutional support and perceived subeffective training still represent obstacles, especially in adult institutions. Sharing effective strategies to address medical racism will help institutions take steps to mitigate inequities.
医疗种族主义会导致不良的健康结果。1 型糖尿病交换质量改进协作组（T1DX-QI）是一个大型的基于人群的队列，致力于数据共享和质量改进，以推动 1 型糖尿病护理系统的变革。年度 T1DX-QI 调查包括评估糖尿病护理中的种族公平性和促进公平的实践的问题。
年度 T1DX-QI 调查于 2022 年秋季向参与的诊所进行，并获得了 93%的回应率。共有 50 份回应（儿科：66%，成人：34%）。部分问题评估了临床资源和种族公平性。将回应数据进行汇总、总结，并按儿科/成人机构进行分层。
只有 21%的儿科机构和 35%的成人机构认为他们所有的团队成员都能阐明医疗种族主义如何导致不良的糖尿病结果。儿科机构报告了比成人机构更多的解决医疗种族主义的策略（3.6 比 3.1）。减少种族歧视的组织策略包括员工培训、公平办公室/委员会、患者资源和招聘实践。患者资源包括翻译服务、交通、保险导航以及住房和食品援助。招聘实践包括改变先前的协议、从社区招聘和多样化员工队伍。大多数机构在过去一年（儿科：85%，成人：72%）和每年（儿科：64%，成人：56%）都提供了反种族主义培训。儿科团队认为他们的反种族主义培训更有效（儿科：60%，成人：45%），并且更经常提供资源（儿科：67%，成人：47%）来帮助解决不平等问题。
尽管增加了反种族主义培训，但机构支持不足和培训效果不佳仍然是障碍，特别是在成人机构。分享解决医疗种族主义的有效策略将有助于机构采取措施减轻不平等。
