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Smith CJ, Raval MV, Simon MA, Henry MCW. Addressing pediatric surgical health inequities through quality improvement efforts. Semin Pediatr Surg 2023; 32:151280. [PMID: 37147217 DOI: 10.1016/j.sempedsurg.2023.151280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Concepts of healthcare quality and health equity should be inextricably linked but are often pursued separately. Quality improvement (QI) can serve as a powerful means to eliminate health inequities by adopting an equity-focused lens to diagnose and address baseline disparities among pediatric populations using targeted interventions. QI and pediatric surgery practitioners should integrate concepts of equity at every stage of formulating a QI project including conceptualization, planning, and execution. Early adaptation of an equity conscious perspective using QI methodology can prevent exacerbation of preexisting disparities while improving overall outcomes.
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Affiliation(s)
- Charesa J Smith
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA; Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA; Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marion C W Henry
- Division of Pediatric Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
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Zimmerman K, Salehani A, Shlobin NA, Oates GR, Rosseau G, Rocque BG, Lam S, Blount JP. Community-engaged research: a powerful tool to reduce health disparities and improve outcomes in pediatric neurosurgery. J Neurosurg Pediatr 2022; 30:364-366. [PMID: 35901691 DOI: 10.3171/2022.5.peds22184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kathrin Zimmerman
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham
| | - Arsalaan Salehani
- 2Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Nathan A Shlobin
- 3Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago
- 4Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gabriela R Oates
- 5Department of Pediatrics, University of Alabama at Birmingham, Alabama; and
| | - Gail Rosseau
- 6Department of Neurosurgery, The George Washington University, Washington, DC
| | - Brandon G Rocque
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham
| | - Sandi Lam
- 3Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago
- 4Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey P Blount
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham
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Bauer MEE, Pike I. Development of a child-centred community-based participatory research approach to injury prevention. Inj Prev 2022; 28:472-475. [PMID: 35301230 DOI: 10.1136/injuryprev-2022-044528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Community-based participatory research (CBPR) approaches to injury prevention are conducted so as to foster inclusiveness and collaboration in research processes and settings. Despite the benefits of using CBPR approaches to represent voices in research that are typically marginalised, they are overwhelmingly used in collaborations with youth and adults. Developing a child-centred CBPR approach can serve the important purpose of fostering awareness for children's voices and needs in injury prevention, and can help future researchers engage communities of children in a genuine and respectful way. PURPOSE To develop a four-staged model of a child-centred CBPR approach to injury prevention and outline the development.
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Affiliation(s)
| | - Ian Pike
- Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
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Adler RR, Smith RN, Fowler KJ, Gates J, Jefferson NM, Adler JT, Patzer RE. Community Based Participatory Research (CBPR): An Underutilized Approach to Address Surgical Disparities. Ann Surg 2022; 275:496-499. [PMID: 34913903 DOI: 10.1097/sla.0000000000005329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Disparities are well-documented across the continuum of surgical care. Counteracting such disparities requires new multidisciplinary approaches that utilize the expertise of affected individuals, such as community-based participatory research (CBPR). CBPR is an approach to research that is anchored in equitable, sustainable community-academic partnerships, and has been shown to improve intervention implementation and outcomes. In this article, community stakeholders and researchers outline the principles and benefits of CBPR, examples of CBPR in trauma and transplant, and future directions for CBPR within surgery.
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Affiliation(s)
- Rachel R Adler
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Randi N Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | | | | | | | - Joel T Adler
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX
| | - Rachel E Patzer
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
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Kain ZN, Fortier MA, Dinh PN, Spanhel K, Campos B. Cultural Adaptation in the Perioperative Space: A Case Study. Anesth Analg 2022; 134:573-577. [PMID: 35180175 DOI: 10.1213/ane.0000000000005876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Zeev N Kain
- From the Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California
- Children's Hospital of Orange County, Orange, California
- Center on Stress & Health, University of California Irvine, Irvine, California
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Michelle A Fortier
- From the Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California
- Children's Hospital of Orange County, Orange, California
- Center on Stress & Health, University of California Irvine, Irvine, California
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California
| | - Peter N Dinh
- From the Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California
- Children's Hospital of Orange County, Orange, California
- Center on Stress & Health, University of California Irvine, Irvine, California
| | - Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Belinda Campos
- Department of Chicano/Latino Studies, University of California Irvine, Irvine, California
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Lo C, Ross PA, Le S, Kim E, Keefer M, Rosales A. Engaging Parents in Analgesia Selection and Racial/Ethnic Differences in Analgesia Given to Pediatric Patients Undergoing Urologic Surgery. CHILDREN-BASEL 2020; 7:children7120277. [PMID: 33297304 PMCID: PMC7762314 DOI: 10.3390/children7120277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Family-centered care aims to consider family preferences and values in care delivery. Our study examines parent decisions regarding anesthesia type (caudal regional block or local anesthesia) among a diverse sample of children undergoing urologic surgeries. Differences in anesthesia type were examined by known predictors of health disparities, including child race/ethnicity, parental English proficiency, and a proxy for household income. METHODS A retrospective review of 4739 patients (including 25.4% non-Latino/a White, 8.7% non- Latino/a Asians, 7.3% non-Latino/a Black, 23.1% Latino/a, and 35.4% others) undergoing urologic surgeries from 2016 to 2020 using univariate and logistic regression analyses. RESULTS 62.1% of Latino/a parents and 60.8% of non-Latino/a Black parents did not agree to a regional block. 65.1% of Spanish-speaking parents with limited English Proficiency did not agree to a regional block. Of parents from households below poverty lines, 61.7% did not agree to a caudal regional block. In regression analysis, Latino/a and non- Latino/a Black youth were less likely to receive caudal regional block than non- Latino/a White patients. CONCLUSIONS We found disparities in the use of pediatric pain management techniques. Understanding mechanisms underlying Latino/a and non- Latino/a Black parental preferences may help providers reduce these disparities.
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Affiliation(s)
- Carl Lo
- Department of Anesthesiology Critical Care Medicine, Division of Pain Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (P.A.R.); (S.L.); (E.K.); (A.R.)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
- Correspondence:
| | - Patrick A. Ross
- Department of Anesthesiology Critical Care Medicine, Division of Pain Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (P.A.R.); (S.L.); (E.K.); (A.R.)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
| | - Sang Le
- Department of Anesthesiology Critical Care Medicine, Division of Pain Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (P.A.R.); (S.L.); (E.K.); (A.R.)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
| | - Eugene Kim
- Department of Anesthesiology Critical Care Medicine, Division of Pain Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (P.A.R.); (S.L.); (E.K.); (A.R.)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
| | - Matthew Keefer
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Alvina Rosales
- Department of Anesthesiology Critical Care Medicine, Division of Pain Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (P.A.R.); (S.L.); (E.K.); (A.R.)
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Palermo TM, Kashikar-Zuck S, Friedrichsdorf SJ, Powers SW. Special considerations in conducting clinical trials of chronic pain management interventions in children and adolescents and their families. Pain Rep 2019; 4:e649. [PMID: 31583334 PMCID: PMC6749908 DOI: 10.1097/pr9.0000000000000649] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/21/2018] [Accepted: 03/03/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Disabling chronic pain is a common experience for children and adolescents. However, the evidence base for chronic pain interventions for youth is extremely limited, which has hindered the development of evidence-based practice guidelines for most pediatric chronic pain conditions. OBJECTIVES To review and provide recommendations on clinical trial design and evaluation in children and adolescents with chronic pain. METHODS In this article, we summarize key issues and provide recommendations for addressing them in clinical trials of chronic pain interventions in children and adolescents and their families. RESULTS To stimulate high-quality trials of pediatric chronic pain management interventions, attention to key issues including sample characterization, trial design and treatment administration, outcome measurement, and the ethics of intervening with children and adolescents, as opposed to adults with chronic pain, is needed. CONCLUSION Future research to develop interventions to reduce or prevent childhood chronic pain is an important priority area, and requires special considerations in implementation and evaluation in clinical trials.
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Affiliation(s)
- Tonya M. Palermo
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Susmita Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stefan J. Friedrichsdorf
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Scott W. Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Expanding the circle of care: Can children find a perioperative surgical home? Can J Anaesth 2017; 64:698-702. [PMID: 28577163 DOI: 10.1007/s12630-017-0889-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/06/2017] [Accepted: 04/13/2017] [Indexed: 10/19/2022] Open
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