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Tekeste R, Grant M, Newton P, Davis NL, Tekeste M, Carter R. Prevalence of Medical Mistrust and Its Impact on Patient Satisfaction in Pediatric Caregivers. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02165-z. [PMID: 39240453 DOI: 10.1007/s40615-024-02165-z] [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: 04/19/2024] [Revised: 07/18/2024] [Accepted: 08/29/2024] [Indexed: 09/07/2024]
Abstract
Racial minorities report lower perceived quality of care received compared to non-Hispanic White Americans, resulting in racial disparities in patient satisfaction. Medical mistrust, defined as a lack of confidence in the medical establishment and the intentions of medical personnel, is more prevalent among racial minority groups and is associated with poorer health outcomes. This study examines the prevalence and racial differences of patient/caregiver medical mistrust and its relationship to patient satisfaction among the pediatric patient population at a large urban academic medical center. A cross-sectional anonymous survey was conducted for caregivers of pediatric families seen at an urban tertiary care facility, including demographic information, the Patient Satisfaction Questionnaire (PSQ), and the Group-Based Medical Mistrust Scale (GBMMS). Linear regressions and mediation analyses were performed, examining race-based medical mistrust and associations with patient satisfaction. Sixty-seven surveys (67% Black/African American, 24% White) were completed. Black/African American participants reported higher levels of medical mistrust (M = 2.29, SD = 0.88 vs. M = 1.37, SD = 0.50; p < .001), which was associated with lower patient satisfaction (p < .001). In a parallel mediation analysis, disaggregating the GBMMS into three subscales, a significant indirect relationship emerged between race and patient satisfaction via the subscale lack of support from healthcare providers (95% CI [- 1.52, - .02], p < .05). Black/African American participants were more likely to have medical mistrust, and greater medical mistrust was significantly associated with lower patient satisfaction. Black/African American participants were significantly more likely to perceive lower support from healthcare providers which, in turn, was associated with lower patient satisfaction. These findings identify potential areas for intervention to improve Black/African American patients' experience with healthcare.
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Affiliation(s)
- R Tekeste
- Mercy Medical Center, Baltimore, MD, USA
| | - M Grant
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - P Newton
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - N L Davis
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - R Carter
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
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Freed GL, Bogan B, Nicholson A, Niedbala D, Woolford S. Error Rates in Race and Ethnicity Designation Across Large Pediatric Health Systems. JAMA Netw Open 2024; 7:e2431073. [PMID: 39226057 PMCID: PMC11372483 DOI: 10.1001/jamanetworkopen.2024.31073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Importance Without knowledge of the degree of misattribution in racial and ethnic designations in data, studies run the risk of missing existing inequities and disparities and identifying others that do not exist. Further, accuracy of racial and ethnic designations is important to clinical care improvement efforts and health outcomes. Objective To determine the error rate of racial and ethnic attribution in the electronic medical records (EMRs) across the 3 largest pediatric health systems in Michigan. Design, Setting, and Participants This cross-sectional study collected race and ethnicity data from parents in outpatient clinics, emergency departments, and inpatient units at the 3 largest pediatric health systems in Michigan. A total of 1594 parents or guardians participated at health system A, 1537 at health system B, and 1202 at health system C from September 1, 2023, to January 31, 2024. Parent or guardian report of race and ethnicity for a child was used as the gold standard for comparison with the designation in the EMR. Exposure Race and ethnicity designations in the EMR. Options for race designation across the health systems ranged from 6 to 49; options for ethnicity, from 2 to 10. Main Outcomes and Measures Matching occurred in 3 stages. First, the exact racial and ethnic designations made by parents for their child were compared with what was found in the EMR. Second, for any child whose parent selected more than 1 racial category or for whom more than 1 appeared in the EMR, the designation of a minoritized racial group was used for matching purposes. Third, starting with the product of stage 2, racial designations were combined or collapsed into 6 (health systems A and C) or 5 (health system B) designations. Results A total of 4333 survey responses were included in the analysis. The greatest error rate across the health systems occurred with the exact match of parental report of racial designation with the EMR, which ranged from 41% to 78% across the health systems. Improvement in the matching rate for each health system occurred with consolidation of race options provided. Differences between the health systems narrowed at the final consolidation to varying from 79% to 88% matching. Ethnicity matching between the EMR and the parental report ranged from 65% to 95% across the health systems. Missing race or ethnicity data in the EMR was counted as a nonmatch. Rates of missing racial data varied across the health systems from 2% to 10%. The health system with the greatest number of options for race and ethnicity had the highest error rates. Conclusions and Relevance Although there will always be some misattribution of race and ethnicity in the EMR, the results of this cross-sectional study suggest that significant error in these data may undermine strategies to improve care. It is unclear whether those in an organization who determine the number of potential categories are the same persons who use those data to investigate potential disparities and inequities.
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Affiliation(s)
- Gary L Freed
- Michigan Child Health Equity Collaborative, Ann Arbor
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
| | - Brittany Bogan
- C. S. Mott Children's Hospital and Von Voigtlander Women's Hospital, Ann Arbor, Michigan
| | - Adam Nicholson
- Corewell Health Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | | | - Susan Woolford
- Michigan Child Health Equity Collaborative, Ann Arbor
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
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Kannikeswaran N, Spencer P, Tedford NJ, Truschel LL, Chu J, Dingeldein L, Waseem M, Chow J, Lababidi A, Theiler C, Bhalodkar S, Yan X, Lou X, Fernandez R, Aronson PL, Lion KC, Gutman CK. Disposition and Follow-up for Low-Risk Febrile Infants: A Secondary Analysis of a Multicenter Study. Hosp Pediatr 2024; 14:e379-e384. [PMID: 39113626 PMCID: PMC11358591 DOI: 10.1542/hpeds.2024-007850] [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] [Received: 03/15/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 09/01/2024]
Abstract
OBJECTIVE American Academy of Pediatrics guidelines recommend that febrile infants at low risk for invasive bacterial infection be discharged from the emergency department (ED) if primary care provider (PCP) follow-up occurs within 24 hours. We aimed to (1) assess the association between having electronic health record (EHR) documentation of a PCP and ED disposition and (2) describe documentation of potential barriers to discharge and plans for post-discharge follow-up in low-risk febrile infants. METHODS We conducted a secondary analysis of a multicenter, cross-sectional study of low-risk febrile infants. Descriptive statistics characterized ED disposition on the basis of the day of the visit, EHR documentation of PCP, scheduled or recommended PCP follow-up, and barriers to discharge. RESULTS Most infants (3565/4042, 90.5%) had EHR documentation of a PCP. Compared with discharged infants, a similar proportion of hospitalized infants had EHR documentation of PCP (90.3% vs 91.2%, P = .47). Few infants (1.5%) had barriers to discharge documented. Of the 3360 infants (83.1%) discharged from the ED, 1544 (46.0%) had documentation of scheduled or recommended 24-hour PCP follow-up. Discharged infants with weekday visits were more likely than those with weekend visits to have documentation of scheduled or recommended 24-hour follow-up (50.0% vs 35.5%, P < .001). CONCLUSIONS Most infants had a documented PCP, yet fewer than half had documentation of a scheduled or recommended 24-hour follow-up. A dedicated focus on determining post-ED care plans that are safe and patient-centered may improve the quality of care for this population.
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Affiliation(s)
- Nirupama Kannikeswaran
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, Michigan
- Division of Emergency Medicine, Children’s Hospital of Michigan, Detroit, Michigan
| | - Priya Spencer
- Division of Emergency Medicine, Children’s Hospital of Michigan, Detroit, Michigan
| | - Natalie J. Tedford
- Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Larissa L. Truschel
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jamie Chu
- Texas Children’s Pediatrics, Houston, Texas
| | - Leslie Dingeldein
- Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Muhammad Waseem
- Department of Pediatrics and Emergency Medicine, Lincoln Medical Center, Bronx, New York
| | - Jessica Chow
- University of California Los Angeles, Department of Emergency Medicine, Los Angeles, California
| | | | - Carly Theiler
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa
| | - Sonali Bhalodkar
- Departments of Pediatrics and Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xinyu Yan
- Biostatistics, College of Public Health and Health Professions
| | - XiangYang Lou
- Biostatistics, College of Public Health and Health Professions
| | | | - Paul L. Aronson
- Departments of Pediatrics and Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - K. Casey Lion
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
| | - Colleen K. Gutman
- Emergency Medicine and Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
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Slain KN, Hall M, Akande M, Thornton JD, Pronovost PJ, Berry JG. Race, Ethnicity, and Intensive Care Utilization for Common Pediatric Diagnoses: U.S. Pediatric Health Information System 2019 Database Study. Pediatr Crit Care Med 2024; 25:828-837. [PMID: 38421235 PMCID: PMC11358360 DOI: 10.1097/pcc.0000000000003487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES Racial and ethnic disparities in healthcare delivery for acutely ill children are pervasive in the United States; it is unknown whether differential critical care utilization exists. DESIGN Retrospective study of the Pediatric Health Information System (PHIS) database. SETTING Multicenter database of academic children's hospitals in the United States. PATIENTS Children discharged from a PHIS hospital in 2019 with one of the top ten medical conditions where PICU utilization was present in greater than or equal to 5% of hospitalizations. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Race and ethnicity categories included Asian, Black, Hispanic, White, and other. Primary outcomes of interest were differences in rate of PICU admission, and for children requiring PICU care, total hospital length of stay (LOS). One-quarter ( n = 44,200) of the 178,134 hospital discharges included a PICU admission. In adjusted models, Black children had greater adjusted odds ratio (aOR [95% CI]) of PICU admission in bronchiolitis (aOR, 1.08 [95% CI, 1.02-1.14]; p = 0.01), respiratory failure (aOR, 1.18 [95% CI, 1.10-1.28]; p < 0.001), seizure (aOR, 1.28 [95% CI, 1.08-1.51]; p = 0.004), and diabetic ketoacidosis (DKA) (aOR, 1.18 [95% CI, 1.05-1.32]; p = 0.006). Together, Hispanic, Asian, and other race children had greater aOR of PICU admission in five of the diagnostic categories, compared with White children. The geometric mean (± sd ) hospital LOS ranged from 47.7 hours (± 2.1 hr) in croup to 206.6 hours (± 2.8 hr) in sepsis. After adjusting for demographics and illness severity, children from families of color had longer LOS in respiratory failure, pneumonia, DKA, and sepsis. CONCLUSIONS The need for critical care to treat acute illness in children may be inequitable. Additional studies are needed to understand and eradicate differences in PICU utilization based on race and ethnicity.
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Affiliation(s)
- Katherine N. Slain
- Department of Pediatrics, Division of Pediatric Critical Care, University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, OH
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS
| | - Manzilat Akande
- The University of Oklahoma College of Medicine, Oklahoma City, OK
| | - J. Daryl Thornton
- Case Western Reserve University School of Medicine, Cleveland, OH
- Center for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, OH
- Center for Population Health Research, MetroHealth Campus of Case Western Reserve University, Cleveland, OH
| | | | - Jay G. Berry
- Complex Care, Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston MA
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Lomax S, Klusaritz H, Jimenez ME, Frausto B, Cahen V, Njoroge W, Yun K. A Secret Shopper Study of Language Accessibility of Community-based Behavioral Health Services for Children in Families Who Speak Spanish and English. J Pediatr 2024:114275. [PMID: 39218205 DOI: 10.1016/j.jpeds.2024.114275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/15/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To compare outpatient behavioral health scheduling for children in Spanish-speaking families in Pennsylvania with that for children in families who speak English. STUDY DESIGN We made paired English and Spanish telephone calls to outpatient behavioral health facilities using a standardized script, describing a simulated, stable, Medicaid-insured child. Facilities were identified using the Pennsylvania Department of Human Services Online Provider Directory for Mental Health and Substance Abuse Services, which had 288 outpatient facilities with non-duplicate telephone numbers. An English-language caller following a script made up to two call attempts per facility from December 2019 through February 2020. The 126 facilities that did not answer the phone, accept Medicaid, or see children were removed. A Spanish-language caller then made up to two scripted call attempts to the 162 remaining facilities. The primary outcome was whether the facility tried to schedule an appointment for the simulated adolescent. RESULTS 125 facilities answered both English- and Spanish-language calls. For the English-language caller, 71% of facilities attempted to schedule an appointment and 100% communicated in the caller's preferred language. For the Spanish-language caller, 24% attempted to schedule an appointment (P<0.001) and 25% communicated in the caller's preferred language (P<0.001). CONCLUSIONS Among outpatient behavioral health facilities for Medicaid-insured children in Pennsylvania, there were inequities in access to appointments for families who speak Spanish compared with English. This a modifiable barrier to care. Community-based behavioral health care for children should strengthen language access training, contracting, and oversight.
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Affiliation(s)
- Silicia Lomax
- University of Pennsylvania, Perelman School of Medicine
| | | | | | | | | | - Wanjiku Njoroge
- University of Pennsylvania, Perelman School of Medicine; Children's Hospital of Philadelphia
| | - Katherine Yun
- University of Pennsylvania, Perelman School of Medicine; Children's Hospital of Philadelphia.
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Wang Y, Wang L, Zhou Z, Laurentiev J, Lakin JR, Zhou L, Hong P. Assessing fairness in machine learning models: A study of racial bias using matched counterparts in mortality prediction for patients with chronic diseases. J Biomed Inform 2024; 156:104677. [PMID: 38876453 PMCID: PMC11272432 DOI: 10.1016/j.jbi.2024.104677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 04/30/2024] [Accepted: 06/11/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE Existing approaches to fairness evaluation often overlook systematic differences in the social determinants of health, like demographics and socioeconomics, among comparison groups, potentially leading to inaccurate or even contradictory conclusions. This study aims to evaluate racial disparities in predicting mortality among patients with chronic diseases using a fairness detection method that considers systematic differences. METHODS We created five datasets from Mass General Brigham's electronic health records (EHR), each focusing on a different chronic condition: congestive heart failure (CHF), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), chronic liver disease (CLD), and dementia. For each dataset, we developed separate machine learning models to predict 1-year mortality and examined racial disparities by comparing prediction performances between Black and White individuals. We compared racial fairness evaluation between the overall Black and White individuals versus their counterparts who were Black and matched White individuals identified by propensity score matching, where the systematic differences were mitigated. RESULTS We identified significant differences between Black and White individuals in age, gender, marital status, education level, smoking status, health insurance type, body mass index, and Charlson comorbidity index (p-value < 0.001). When examining matched Black and White subpopulations identified through propensity score matching, significant differences between particular covariates existed. We observed weaker significance levels in the CHF cohort for insurance type (p = 0.043), in the CKD cohort for insurance type (p = 0.005) and education level (p = 0.016), and in the dementia cohort for body mass index (p = 0.041); with no significant differences for other covariates. When examining mortality prediction models across the five study cohorts, we conducted a comparison of fairness evaluations before and after mitigating systematic differences. We revealed significant differences in the CHF cohort with p-values of 0.021 and 0.001 in terms of F1 measure and Sensitivity for the AdaBoost model, and p-values of 0.014 and 0.003 in terms of F1 measure and Sensitivity for the MLP model, respectively. DISCUSSION AND CONCLUSION This study contributes to research on fairness assessment by focusing on the examination of systematic disparities and underscores the potential for revealing racial bias in machine learning models used in clinical settings.
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Affiliation(s)
| | - Liqin Wang
- Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - Joshua R Lakin
- Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Li Zhou
- Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Asp RA, Paquette ET. Parent Perspectives on Social Risk Screening in the PICU. Pediatr Crit Care Med 2024:00130478-990000000-00364. [PMID: 39016706 DOI: 10.1097/pcc.0000000000003580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
OBJECTIVE Health inequities are widespread and associated with avoidable poor health outcomes. In the PICU, we are increasingly understanding how health inequities relate to critical illness and health outcomes. Experts recommend assessing for health inequities by screening for social determinants of health (SDOH) and adverse childhood experiences (ACEs); however, guidance on screening is limited and screening has not been universally implemented. Our study aimed to understand parent perspectives on screening for SDOH/ACEs in the PICU, with the primary objective of determining whether screening would be acceptable in this setting. DESIGN We conducted a qualitative study using semistructured interviews with a convenience sample of eleven PICU parents between November 2021 and January 2022. SETTING Urban, quaternary free-standing children's hospital. SUBJECTS Parents of children with a PICU hospitalization between November 2020 and October 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Domains of interest included experience with and attitudes toward SDOH/ACEs screening, perspectives on addressing needs with/without resources and their relationship to health, and recommendations for screening. Interviews were transcribed verbatim and coded with an inductive approach using thematic analysis and constant comparative methods. Ann & Robert H. Lurie Children's Institutional Review Board approved this study (2021- 4781, Approved September 13, 2021). Ten participants found SDOH/ACEs screening to be acceptable and valuable in the PICU, even for topics without a readily available resource. Participants did not have broad experience with ACEs screening, though all believed this provided the medical team with valuable context regarding their child. Ten participants recommended screening occur after their child has been stabilized and that they are notified that screening is universal. CONCLUSIONS Participants found screening for SDOH/ACES to be acceptable and valuable in the PICU. Families have important insight that should be leveraged to improve the support of unmet needs through the development of strengths-based, parent-informed screening initiatives.
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Affiliation(s)
- Rebecca A Asp
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Erin T Paquette
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern University Pritzker School of Law (by courtesy), Chicago, IL
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Cook NE, Kissinger-Knox A, Iverson IA, Stephenson K, Norman MA, Hunter AA, Saadi A, Iverson GL. Social Determinants of Health and Health Equity in the Treatment and Rehabilitation of Sport-Related Concussion: A Content Analysis of Intervention Research and Call-To-Action. J Neurotrauma 2024. [PMID: 38753708 DOI: 10.1089/neu.2023.0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
This review was designed to (1) determine the extent to which the clinical science on sport-related concussion treatment and rehabilitation has considered social determinants of health (SDoH) or health equity and (2) offer recommendations to enhance the incorporation of SDoH and health equity in concussion treatment research and clinical care. The Concussion in Sport Group consensus statement (2023) was informed by two systematic reviews examining prescribed rest or exercise following concussion and targeted interventions to facilitate concussion recovery. We examined 31 studies, including 2,698 participants, from those two reviews. Race (k = 6; 19.4%) and ethnicity (k = 4; 12.9%) of the study samples were usually not reported. Four studies examined ethnicity (i.e., Hispanic), exclusively as a demographic category. Five studies (16.1%) examined race as a demographic category. Three studies (9.7%) examined socioeconomic status (SES; measured as household income) as a demographic category/sample descriptor and one study (3.2%) examined SES in-depth, by testing whether the treatment and control groups differed by SES. Five studies examined an SDoH domain in a descriptive manner and four studies in an inferential/intentional manner. No study mentioned SDoH, health equity, or disparities by name. Many studies (61.3%) excluded participants based on demographic, sociocultural, or health factors, primarily due to language proficiency. The new consensus statement includes recommendations for concussion treatment and rehabilitation that rely on an evidence base that has not included SDoH or studies addressing health equity. Researchers are encouraged to design treatment and rehabilitation studies that focus specifically on underrepresented groups to determine if they have specific and unique treatment and rehabilitation needs, whether certain practical modifications to treatment protocols might be necessary, and whether completion rates and treatment adherence and response are similar.
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Affiliation(s)
- Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Mass General for Children Sports Concussion Program, Waltham, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Concussion Research Program, Spaulding Hospital Cambridge, Cambridge, MA, USA
| | - Ila A Iverson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Katie Stephenson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Marc A Norman
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
| | - Amy A Hunter
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
- Injury Prevention Center, Connecticut Children's Medical Center and Hartford Hospital, Hartford, CT, USA
| | - Altaf Saadi
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Mass General for Children Sports Concussion Program, Waltham, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Concussion Research Program, Spaulding Hospital Cambridge, Cambridge, MA, USA
- Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, USA
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Raval VV, Gopal B, Aggarwal P, Mohan MP, Padmakumari P, Thomas E, Luebbe AM, Hay MC. Training in Cultural Competence for Mental Health Care: A Mixed-Methods Study of Students, Faculty, and Practitioners from India and USA. Cult Med Psychiatry 2024:10.1007/s11013-024-09867-3. [PMID: 38954183 DOI: 10.1007/s11013-024-09867-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/04/2024]
Abstract
Although the need to train clinicians to provide effective mental health care to individuals from diverse backgrounds has been recognized worldwide, a bulk of what we know about training in cultural competence (CC) is based on research conducted in the United States. Research on CC in mental health training from different world populations is needed due to the context-dependent nature of CC. Focusing on India and USA, two diverse countries that provide complementary contexts to examine CC, we explored graduate students', practicing clinicians', and faculty members' perspectives regarding CC training they received/provided and future training needs using mixed-methods. The data were collected using focus groups (n = 25 groups total: 15 in India, 11 in USA), and a survey (n = 800: 450 in India, 350 in USA). Our data highlight the salient social identities in these countries, and the corresponding constituents of CC training. Participants in India described a practical emphasis to their CC training (e.g., learning about CC through life experiences and clinical practice experiences) more so than through coursework, whereas participants in USA described varying levels of coursework related to CC along with practice. Participants in both countries considered enormity of CC as a challenge, while those in the US also identified CC training limited to a white, straight, male perspective, hesitancy in engaging with diversity topics, and limited time and competence of the faculty. Strengths of CC training in India and USA are mutually informative in generating recommendations for enhancing the training in both countries.
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Affiliation(s)
- Vaishali V Raval
- Miami University, Oxford, OH, USA.
- Department of Psychology, Miami University, 90 N Patterson Ave., Oxford, OH, 45056, USA.
| | - Baiju Gopal
- CHRIST (Deemed to be) University, Bengaluru, India
| | | | | | - P Padmakumari
- Miami University, Oxford, OH, USA
- CHRIST (Deemed to be) University, Bengaluru, India
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Belza CC, Sheahan L, Becker M, Gosman AA. Geospatial and Socioeconomic Disparities Influencing the Management and Outcomes of Nonsyndromic Craniosynostosis: A Systematic Review. J Craniofac Surg 2024; 35:1334-1337. [PMID: 39042067 DOI: 10.1097/scs.0000000000010162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/19/2024] [Indexed: 07/24/2024] Open
Abstract
Geospatial and socioeconomic health disparities are potential barriers to timely diagnosis and treatment of nonsyndromic craniosynostosis. This systematic review aims to assess published literature describing disparities in craniosynostosis care and to summarize the findings surrounding patient proximity to care centers and familial socioeconomic status as predictors of surgical management and outcomes. The data sources used include PubMed, MEDLINE, and Google Scholar. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for appraisal of the quality of the studies included. Generally, the literature reviewed suggested that socioeconomic variables including race, insurance payor, and median zip code income quartile are predictors of suboptimal craniosynostosis surgical management outcomes including older age at time of surgery and more invasive surgical approach performed. The only geospatial data element assessed was the general region of the hospital where the patient was treated. The review highlighted various knowledge gaps within published literature describing health-related disparities in patients with craniosynostosis. There is a paucity of research assessing geospatial access to craniosynostosis care centers, suggesting that further research should be performed to evaluate this potential disparity. In addition, previous studies lack granularity when assessing socioeconomic factors and only one study accounted for suture fused, which is a potential confounding variable across the other published work. These considerations should be addressed in future studies addressing this topic. The limitations of this review include potential publication bias given that unpublished work was not included. An element of reviewer bias also exists considering only one reviewer screened the articles and extracted the data.
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Affiliation(s)
| | - Lucy Sheahan
- Department of Surgery, Division of Plastic Surgery, School of Medicine, University of California San Diego, La Jolla, CA
| | | | - Amanda A Gosman
- Department of Surgery, Division of Plastic Surgery, School of Medicine, University of California San Diego, La Jolla, CA
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Alizadeh F, Gauvreau K, Barreto JA, Hall M, Bucholz E, Nathan M, Newburger JW, Vitali S, Thiagarajan RR, Chan T, Moynihan KM. Child Opportunity Index and Pediatric Extracorporeal Membrane Oxygenation Outcomes; the Role of Diagnostic Category. Crit Care Med 2024:00003246-990000000-00351. [PMID: 38920540 DOI: 10.1097/ccm.0000000000006358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
OBJECTIVES To study the impact of social determinants of health (SDoH) on pediatric extracorporeal membrane oxygenation (ECMO) outcomes. DESIGN, SETTING, AND PATIENTS Retrospective study of children (< 18 yr) supported on ECMO (October 1, 2015 to March 1, 2021) using Pediatric Health Information System (44 U.S. children's hospitals). Patients were divided into five diagnostic categories: neonatal cardiac, pediatric cardiac, neonatal respiratory, pediatric respiratory, and sepsis. SDoH included the Child Opportunity Index (COI; higher indicates social advantage), race, ethnicity, payer, and U.S. region. Children without COI were excluded. Diagnostic category-specific clinical variables related to baseline health and illness severity were collected. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Children supported on ECMO experienced a 33% in-hospital mortality (2863/8710). Overall, children with lower COI, "other" race, Hispanic ethnicity, public insurance and from South or West regions had greater mortality. Associations between SDoH and ECMO outcomes differed between diagnostic cohorts. Bivariate analyses found that only pediatric cardiac patients had an association between COI or race and mortality. Multivariable logistic regression analyses examined relationships between SDoH, clinical variables and mortality within diagnostic categories. Pediatric cardiac patients had 5% increased odds of death (95% CI, 1.01-1.09) for every 10-point decrement in COI, while Hispanic ethnicity was associated with higher survival (adjusted odds ratio [aOR] 0.72 [0.57-0.89]). Children with heart disease from the highest COI quintile had less cardiac-surgical complexity and earlier cannulation. Independent associations with mortality were observed in sepsis for Black race (aOR 1.62 [1.06-2.47]) and other payer in pediatric respiratory patients (aOR 1.94 [1.23-3.06]). CONCLUSIONS SDoH are statistically associated with pediatric ECMO outcomes; however, associations differ between diagnostic categories. Influence of COI was observed only in cardiac patients while payer, race, and ethnicity results varied. Further research should investigate differences between diagnostic cohorts and age groups to understand drivers of inequitable outcomes.
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Affiliation(s)
- Faraz Alizadeh
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Jessica A Barreto
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Matt Hall
- Children's Hospital Association, Lenexa, KS
| | - Emily Bucholz
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Sally Vitali
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
- Department of Anesthesia, Harvard Medical School, Boston, MA
| | - Ravi R Thiagarajan
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Titus Chan
- The Heart Center, Seattle Children's Hospital, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Katie M Moynihan
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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12
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Mahmood A, Kedia S, Arshad H, Mou X, Dillon PJ. Disparities in Access to Mental Health Services Among Children Diagnosed with Anxiety and Depression in the United States. Community Ment Health J 2024:10.1007/s10597-024-01305-3. [PMID: 38907843 DOI: 10.1007/s10597-024-01305-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/24/2024] [Indexed: 06/24/2024]
Abstract
Child and adolescent mental health are major public health concerns in the US. Overall, 20% of US children have a reported mental health condition, while an estimated 40% will be diagnosed with one by age 18. Despite these concerns, little is known about factors associated with access to mental health services among children and adolescents. We analyzed data from a sample of 6655 children (aged 6 to 17 years) with either anxiety and/or depression drawn from the 2020-2021 National Survey of Children's Health (NSCH). A multivariable logistic regression model was fit to investigate predisposing, enabling, and need factors associated with caregiver's (i.e., parent or other guardian) perceived access to mental health services for their children. Approximately 50.8% of caregivers perceived obtaining mental health services for their children to be somewhat difficult, very difficult, or impossible. Children meeting criteria for having a medical home had lower odds of experiencing such difficulties (adjusted [a]OR = 0.38; 95% CI: 0.30-0.49). Further, compared to children who sometimes or never had health insurance coverage for mental or behavioral health needs, children who were always insured (aOR: 0.19; 95% CI 0.14, 0.25) and those who usually had coverage (aOR: 0.38; 95% CI 0.28, 0.51) had lower odds of experiencing perceived difficulties in obtaining care. The results indicate several enabling and need predictors of perceived access to mental health services--highlighting potential structural barriers to care access. Efforts to address access challenges should adopt a multifaceted approach and be tailored to families living in poverty, those with limited health coverage, and minoritized children with less than optimal general health.
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Affiliation(s)
- Asos Mahmood
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, 956 Court Ave Avenue, Ste D222A, Memphis, TN, 38103, USA.
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Hassan Arshad
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Xichen Mou
- Division of Epidemiology, Biostatistics, Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
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13
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Fahey N, Holt A, Cataltepe D, Brochier A, Stern A, Mazanec M, Courtemanche JW, Wilkie T, Tan K, Lyu R, Alper E, Fowler J, Rhein L, Garg A. Understanding barriers to well-child visit attendance among racial and ethnic minority parents. BMC PRIMARY CARE 2024; 25:196. [PMID: 38831259 PMCID: PMC11149240 DOI: 10.1186/s12875-024-02442-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/22/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES To assess racial and ethnic minority parents' perceptions about barriers to well-child visit attendance. METHODS For this cross-sectional qualitative study, we recruited parents of pediatric primary care patients who were overdue for a well-child visit from the largest safety net healthcare organization in central Massachusetts to participate in semi-structured interviews. The interviews focused on understanding potential knowledge, structural, and experiential barriers for well-child visit attendance. Interview content was inductively coded and directed content analysis was performed to identify themes. RESULTS Twenty-five racial and ethnic minority parents participated; 17 (68%) of whom identified Spanish as a primary language spoken at home. Nearly all participants identified the purpose, significance, and value of well-child visits. Structural barriers were most cited as challenges to attending well-child visits, including parking, transportation, language, appointment availability, and work/other competing priorities. While language emerged as a distinct barrier, it also exacerbated some of the structural barriers identified. Experiential barriers were cited less commonly than structural barriers and included interactions with office staff, racial/ethnic discrimination, appointment reminders, methods of communication, wait time, and interactions with providers. CONCLUSIONS Racial and ethnic minority parents recognize the value of well-child visits; however, they commonly encounter structural barriers that limit access to care. Furthermore, a non-English primary language compounds the impact of these structural barriers. Understanding these barriers is important to inform health system policies to enhance access and delivery of pediatric care with a lens toward reducing racial and ethnic-based inequities.
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Affiliation(s)
- Nisha Fahey
- UMass Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA.
| | - Allison Holt
- UMass Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA
| | | | | | - Amy Stern
- Massachusetts Health Quality Partners, Brighton, MA, USA
| | | | | | | | - Kellie Tan
- UMass Memorial Health, Worcester, MA, USA
| | - Rulan Lyu
- UMass Memorial Health, Worcester, MA, USA
| | - Eric Alper
- UMass Memorial Health, Worcester, MA, USA
| | - Josephine Fowler
- UMass Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA
| | - Lawrence Rhein
- UMass Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA
| | - Arvin Garg
- UMass Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA
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14
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Stevens AJ, Boukari Y, English S, Kadir A, Kumar BN, Devakumar D. Discriminatory, racist and xenophobic policies and practice against child refugees, asylum seekers and undocumented migrants in European health systems. THE LANCET REGIONAL HEALTH. EUROPE 2024; 41:100834. [PMID: 39119094 PMCID: PMC11306214 DOI: 10.1016/j.lanepe.2023.100834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 08/10/2024]
Abstract
Child refugees, asylum seekers and undocumented migrants who have been forcibly displaced from their countries of origin have heightened health needs as a consequence of their migration experiences. Host countries have a duty to respond to these needs, yet across Europe we are seeing a rise in potentially harmful discriminative, hostile and restrictive migration policies and practices. Research exploring the role racism, xenophobia and discrimination in European health systems may play in child migrant health inequities is lacking. This Personal View seeks to highlight this knowledge gap and stimulate discourse on how discrimination in health information systems, data sharing practices, national health policy, healthcare entitlements, service access, quality of care, and healthcare workers attitudes and behaviours may infringe upon the rights of, and impact the health of child refugees, asylum-seekers and undocumented migrants. It calls for action to prevent and mitigate against potentially harmful policies and practices.
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Affiliation(s)
| | - Yamina Boukari
- Institute of Health Informatics, University College London, UK
| | - Sonora English
- Institute for Global Health, University College London, London, UK
| | - Ayesha Kadir
- Save the Children International, St Vincent House, London, UK
| | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
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15
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Figueroa CA, Pérez-Flores NJ, Guan KW, Stiles-Shields C. Diversity, equity and inclusion considerations in mental health apps for young people: protocol for a scoping review. BMJ Open 2024; 14:e081673. [PMID: 38719322 PMCID: PMC11086474 DOI: 10.1136/bmjopen-2023-081673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/26/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION After COVID-19, a global mental health crisis affects young people, with one in five youth experiencing mental health problems worldwide. Delivering mental health interventions via mobile devices is a promising strategy to address the treatment gap. Mental health apps are effective for adolescent and young adult samples, but face challenges such as low real-world reach and under-representation of minoritised youth. To increase digital health uptake, including among minoritised youth, there is a need for diversity, equity and inclusion (DEI) considerations in the development and evaluation of mental health apps. How well DEI is integrated into youth mental health apps has not been comprehensively assessed. This scoping review aims to examine to what extent DEI considerations are integrated into the design and evaluation of youth mental health apps and report on youth, caregiver and other stakeholder involvement. METHODS AND ANALYSIS We will identify studies published in English from 2009 to 29 September 2023 on apps for mental health in youth. We will use PubMed, Global Health, APA PsycINFO, SCOPUS, CINAHL PLUS and the Cochrane Database and will report according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Papers eligible for inclusion must be peer-reviewed publications in English involving smartphone applications used by adolescents or young adults aged 10-25, with a focus on depression, anxiety or suicidal ideation. Two independent reviewers will review and extract articles using a template developed by the authors. We will analyse the data using narrative synthesis and descriptive statistics. This study will identify gaps in the literature and provide a roadmap for equitable and inclusive mental health apps for youth. ETHICS AND DISSEMINATION Ethics approval is not required. Findings will be disseminated through academic, industry, community networks and scientific publications.
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Affiliation(s)
- Caroline A Figueroa
- Policy, Technology and Management, Delft University of Technology, Delft, The Netherlands
- School of Social Welfare, University of California Berkeley, Berkeley, California, USA
| | - Nancy J Pérez-Flores
- Brown School of Social Work, Washington University in St Louis, St Louis, Missouri, USA
| | - Kathleen W Guan
- Policy, Technology and Management, Delft University of Technology, Delft, The Netherlands
| | - Colleen Stiles-Shields
- Institute for Juvenile Research and Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
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16
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Mancilla-Martinez J, Oh MH, Luk G, Rollins A. Special Education Representation Trends Vary by Language Status: Evidence of Underrepresentation in Tennessee. JOURNAL OF LEARNING DISABILITIES 2024; 57:153-167. [PMID: 37309592 PMCID: PMC11044507 DOI: 10.1177/00222194231178285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Using U.S. state-level data, we report unadjusted and adjusted odds ratio of special education (SPED) trends in Tennessee from 2009 to 2019 for students in Grades 3 to 8 by three language groups: native English speakers (NES), English-proficient bilinguals (EPB), and Current English learners (Current EL). We report trends across all SPED disability categories and across five prevalent disability categories (specific learning disability, specific language impairment, intellectual disability, other health impairments, and autism). The cross-sectional analytic sample included 812,783 students from 28 districts that met the SPED risk ratio threshold set by the state. Results revealed that, compared with NES students, both EPB and Current EL students were generally less likely to receive SPED services, suggesting evidence of language status disparities in SPED representation. Furthermore, findings varied depending on whether adjustments were made to generate odds ratios, especially for higher-incidence disabilities (specific learning disability, specific language impairment, and intellectual disability). Finally, the most severe evidence of underrepresentation was in lower-incidence disabilities (other health impairments and autism). Our results underscore the need for further examination into low rates of SPED identification among learners whose first language is not English (EPB and Current EL). We discuss the contextualized research, practice, and policy implications of our findings.
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Affiliation(s)
| | - Min Hyun Oh
- University of Virginia, Charlottesville, USA
| | - Gigi Luk
- McGill University, Montreal, Quebec, Canada
| | - Adam Rollins
- Tennessee Department of Education, Nashville, USA
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17
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Ruiz Colón GD, Barros Guinle MI, Wu A, Grant GA, Prolo LM. Neurosurgical Outcomes Among Non-English Speakers: A Systematic Review and a Framework for Future Research. World Neurosurg 2024; 185:338-350.e1. [PMID: 38387790 DOI: 10.1016/j.wneu.2024.02.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE In 2019, 22% of adults in the United States reported speaking a language other than English at home, representing 52% growth since 2000. This diversity in languages - and resulting possible communication barriers - represents a potential challenge to effective care. In this manuscript, we summarize clinical outcomes and healthcare utilization patterns of adult and pediatric neurosurgical patients who are non-English primary language speakers (NEPLS). METHODS We systematically queried 5 databases from inception through October 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to identify studies for inclusion. The Newcastle-Ottawa Scale was used to assess the quality of studies. Additionally, a retrospective chart review was conducted to assess differences in postoperative communication patterns in a cohort of English and Spanish speaking patients with craniosynostosis at our institution. RESULTS Our search yielded 442 abstracts; ten were included in the final cohort. Outcomes for 973 unique NEPLS with a neurosurgical condition were included; Spanish was the most represented language. Delivery and timing of surgical treatment was the most frequently reported metric; 75% of studies demonstrated a statistically significant delay in time to surgery or decreased likelihood for NEPLS to receive surgical treatment. Length of stay was reported in 3 studies; all demonstrated that NEPLS had longer length of stay. CONCLUSIONS There is a paucity of literature reporting outcomes among NEPLS. It is critical to examine NEPLS patients' outcomes and experiences, as language barriers are potentially modifiable demographic factors. We present a framework that demonstrates opportunities for further research to improve quality of care.
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Affiliation(s)
- Gabriela D Ruiz Colón
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | | | - Adela Wu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura M Prolo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford, California, USA.
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18
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Herrera A, Hall M, Alex Ahearn M, Ahuja A, Bradford KK, Campbell RA, Chatterjee A, Coletti HY, Crowder VL, Dancel R, Diaz M, Fuchs J, Guidici J, Lewis E, Stephens JR, Sutton AG, Sweeney A, Ward KM, Weinberg S, Zwemer EK, Harrison WN. Differences in testing for drugs of abuse amongst racial and ethnic groups at children's hospitals. J Hosp Med 2024; 19:368-376. [PMID: 38383949 DOI: 10.1002/jhm.13305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/13/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES Racial and ethnic differences in drug testing have been described among adults and newborns. Less is known regarding testing patterns among children and adolescents. We sought to describe the association between race and ethnicity and drug testing at US children's hospitals. We hypothesized that non-Hispanic White children undergo drug testing less often than children from other groups. METHODS We conducted a retrospective cohort study of emergency department (ED)-only encounters and hospitalizations for children diagnosed with a condition for which drug testing may be indicated (abuse or neglect, burns, malnutrition, head injury, vomiting, altered mental status or syncope, psychiatric, self-harm, and seizure) at 41 children's hospitals participating in the Pediatric Health Information System during 2018 and 2021. We compared drug testing rates among (non-Hispanic) Asian, (non-Hispanic) Black, Hispanic, and (non-Hispanic) White children overall, by condition and patient cohort (ED-only vs. hospitalized) and across hospitals. RESULTS Among 920,755 encounters, 13.6% underwent drug testing. Black children were tested at significantly higher rates overall (adjusted odds ratio [aOR]: 1.18; 1.05-1.33) than White children. Black-White testing differences were observed in the hospitalized cohort (aOR: 1.42; 1.18-1.69) but not among ED-only encounters (aOR: 1.07; 0.92-1.26). Asian, Hispanic, and White children underwent testing at similar rates. Testing varied by diagnosis and across hospitals. CONCLUSIONS Hospitalized Black children were more likely than White children to undergo drug testing at US children's hospitals, though this varied by diagnosis and hospital. Our results support efforts to better understand and address healthcare disparities, including the contributions of implicit bias and structural racism.
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Affiliation(s)
- Adriana Herrera
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matt Hall
- Department of Analytics, Children's Hospital Association, Lenexa, Kansas, USA
| | - Marshall Alex Ahearn
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Arshiya Ahuja
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathleen K Bradford
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert A Campbell
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashmita Chatterjee
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hannah Y Coletti
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Virginia L Crowder
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ria Dancel
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melissa Diaz
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer Fuchs
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica Guidici
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emilee Lewis
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John R Stephens
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashley G Sutton
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alison Sweeney
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kelley M Ward
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steven Weinberg
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eric K Zwemer
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wade N Harrison
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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19
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Schechter SB, Bowles A, Ding L, Nkoy F, Tieder J, Lion KC, Meyer D, Kaiser SV. Hospital-Based Pediatric Quality Improvement Interventions and Health Disparities: A Scoping Review of the Literature. Pediatrics 2024; 153:e2022061176. [PMID: 38666310 DOI: 10.1542/peds.2022-061176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Quality improvement (QI) has the potential to reduce health disparities through multiple mechanisms, including by standardizing care and addressing social barriers to health. National organizations require that hospital systems integrate equity into quality efforts, but effective approaches remain unclear. We aimed to examine the association of hospital-based pediatric QI interventions and racial and ethnic, language, and socioeconomic disparities in health outcomes. METHODS Quantitative studies from January 1, 2000 to December 11, 2023 reporting the effects of pediatric hospital-based QI were selected from PubMed and Embase. Studies were excluded if outcomes were not stratified by race and ethnicity, language, or socioeconomic status. Studies were reviewed in duplicate for inclusion and by 1 author for data extraction. RESULTS A total of 22 studies were included. Most studies (n = 19, 86%) revealed preexisting disparities, and 68% of those (n = 13) found disparities reductions post-intervention. Studies with disparity-focused objectives or interventions more commonly found reduced disparities than studies of general QI (85% vs 33%). Hospital-based process standardization was associated with reduced disparities in provider practices. Most interventions associated with reduced disparities in patient-facing outcomes involved community/ambulatory partnership. Limitations included potential exclusion of relevant studies, topic heterogenity, and risk of bias. CONCLUSIONS Although the authors of few published hospital-based QI initiatives assessed their equity effect, intentionally designed QI studies were associated with reduced disparities. Interventions focused on care standardization may reduce disparities in care quality, although multilevel interventions are likely needed to affect the health care structures that influence more significant patient outcomes.
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Affiliation(s)
| | - Adria Bowles
- University of California, San Francisco, San Francisco, California
| | - Lucky Ding
- University of California, San Francisco, San Francisco, California
| | - Flory Nkoy
- University of Utah, Salt Lake City, Utah
| | - Joel Tieder
- University of Washington, Seattle, Washington
| | | | - Dodi Meyer
- Columbia University Irving Medical Center, New York, New York
| | - Sunitha V Kaiser
- University of California, San Francisco, San Francisco, California
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20
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Andrist E, Clarke RG, Phelps KB, Dews AL, Rodenbough A, Rose JA, Zurca AD, Lawal N, Maratta C, Slain KN. Understanding Disparities in the Pediatric ICU: A Scoping Review. Pediatrics 2024; 153:e2023063415. [PMID: 38639640 DOI: 10.1542/peds.2023-063415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Health disparities are pervasive in pediatrics. We aimed to describe disparities among patients who are likely to be cared for in the PICU and delineate how sociodemographic data are collected and categorized. METHODS Using MEDLINE as a data source, we identified studies which included an objective to assess sociodemographic disparities among PICU patients in the United States. We created a review rubric, which included methods of sociodemographic data collection and analysis, outcome and exposure variables assessed, and study findings. Two authors reviewed every study. We used the National Institute on Minority Health and Health Disparities Research Framework to organize outcome and exposure variables. RESULTS The 136 studies included used variable methods of sociodemographic data collection and analysis. A total of 30 of 124 studies (24%) assessing racial disparities used self- or parent-identified race. More than half of the studies (52%) dichotomized race as white and "nonwhite" or "other" in some analyses. Socioeconomic status (SES) indicators also varied; only insurance status was used in a majority of studies (72%) evaluating SES. Consistent, although not uniform, disadvantages existed for racial minority populations and patients with indicators of lower SES. The authors of only 1 study evaluated an intervention intended to mitigate health disparities. Requiring a stated objective to evaluate disparities aimed to increase the methodologic rigor of included studies but excluded some available literature. CONCLUSIONS Variable, flawed methodologies diminish our understanding of disparities in the PICU. Meaningfully understanding and addressing health inequity requires refining how we collect, analyze, and interpret relevant data.
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Affiliation(s)
- Erica Andrist
- Division of Pediatric Critical Care Medicine
- Departments of Pediatrics
| | - Rachel G Clarke
- Division of Pediatric Critical Care Medicine, Upstate University Hospital, Syracuse, New York
- Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, New York
| | - Kayla B Phelps
- Division of Pediatric Critical Care Medicine, Louisiana State University Health Sciences Center, Children's Hospital of New Orleans, New Orleans, Louisiana
| | - Alyssa L Dews
- Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan
- Susan B. Meister Child Health and Adolescent Research Center, University of Michigan, Ann Arbor, Michigan
| | - Anna Rodenbough
- Division of Pediatric Critical Care Medicine, Children's Hospital of Atlanta, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Jerri A Rose
- Pediatric Emergency Medicine
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Adrian D Zurca
- Division of Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nurah Lawal
- Stepping Stones Pediatric Palliative Care Program, C.S. Mott Children's Hospital, Ann Arbor, Michigan
- Departments of Pediatrics
| | - Christina Maratta
- Department of Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Katherine N Slain
- Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
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21
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Dickson KS, Holt T, Arredondo EM. Enhancing Behavioral Health Implementation in a Care Coordination Program at a Federally Qualified Health Center: A Case Study Applying Implementation Frameworks. Health Promot Pract 2024:15248399241237958. [PMID: 38504420 DOI: 10.1177/15248399241237958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Federally Qualified Health Centers are charged with providing comprehensive health care in traditionally underserved areas, underscoring their importance in caring for and promoting health equity for the large portion of historically marginalized communities in this setting. There is a significant need to ensure Federally Qualified Health Centers are equipped to appropriately address the immense behavioral health needs common among patients served. Care coordination is an evidence-based model that is increasingly utilized in Federally Qualified Health Centers to improve care equity and outcomes. Addressing and supporting behavioral health needs is a key aspect of such care coordination models. Context-specific considerations and programmatic supports, particularly those that address the needs of care coordinators and the complex patients they serve, are needed to ensure such models can appropriately meet and address the behavioral health concerns of the diverse populations served. The goal of this study was to present a mixed-methods case study that systematically applies implementation frameworks to conduct a needs and context assessment to inform the development and testing of evidence-based practice strategies and implementation support as part of a care coordination program within a partnered Federally Qualified Health Center.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Tana Holt
- San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
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22
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Omoruyi EA, Brown CL, Orr CJ, Montez K. Examining Full-Time Academic General Pediatric Faculty Compensation by Gender, Race, and Ethnicity: 2020-2021. Acad Pediatr 2024; 24:309-317. [PMID: 37285912 PMCID: PMC11177246 DOI: 10.1016/j.acap.2023.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/22/2023] [Accepted: 05/27/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE In medicine, women have lower lifetime earnings than men. To our knowledge, an in-depth examination of academic general pediatric faculty compensation by gender, race, and ethnicity has not been conducted. We aimed to 1) explore full-time academic general pediatric faculty salary differences by race and ethnicity; 2) explore these differences among all full-time pediatric faculty. METHODS We performed a cross-sectional study using data on median full-time academic general pediatric faculty compensation for the academic year of 2020-2021 from the Association of American Medical Colleges Medical School Faculty Salary Survey report. Pearson's chi-square tests were used to evaluate the association of faculty rank with gender, race, ethnicity, and degree. We used hierarchical generalize linear models with a log link and a gamma distribution to model to assess the association of median salary with faculty race and ethnicity, adjusting for degree, rank, and gender. RESULTS Men academic general pediatric faculty consistently had higher median salaries than women faculty even after adjusting for degree, rank, race, and ethnicity. Underrepresented in medicine academic general pediatric faculty had a lower median salary when compared to White faculty, and this was similar when adjusted for degree, rank, race, and ethnicity. CONCLUSIONS Our results demonstrated broad disparities in general academic pediatric compensation by both gender and race and ethnicity. Academic medical centers must identify, acknowledge, and address inequities in compensation models.
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Affiliation(s)
- Emma A Omoruyi
- Department of Pediatrics (EA Omoruyi), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex.
| | - Callie L Brown
- Department of Pediatrics, Department of Epidemiology and Prevention (CL Brown), Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Colin J Orr
- Department of Pediatrics (CJ Orr), University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Kimberly Montez
- Department of Pediatrics, Department of Social Sciences and Health Policy (K Montez), Wake Forest University School of Medicine, Winston-Salem, NC.
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23
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Parikh K, Hall M, Tieder JS, Dixon G, Ward MC, Hinds PS, Goyal MK, Rangel SJ, Flores G, Kaiser SV. Disparities in Racial, Ethnic, and Payer Groups for Pediatric Safety Events in US Hospitals. Pediatrics 2024; 153:e2023063714. [PMID: 38343330 DOI: 10.1542/peds.2023-063714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Health care disparities are pervasive, but little is known about disparities in pediatric safety. We analyzed a national sample of hospitalizations to identify disparities in safety events. METHODS In this population-based, retrospective cohort study of the 2019 Kids' Inpatient Database, independent variables were race, ethnicity, and payer. Outcomes were Agency for Healthcare Research and Quality pediatric safety indicators (PDIs). Risk-adjusted odds ratios were calculated using white and private payer reference groups. Differences by payer were evaluated by stratifying race and ethnicity. RESULTS Race and ethnicity of the 5 243 750 discharged patients were white, 46%; Hispanic, 19%; Black, 15%; missing, 8%; other race/multiracial, 7%, Asian American/Pacific Islander, 5%; and Native American, 1%. PDI rates (per 10 000 discharges) were 331.4 for neonatal blood stream infection, 267.5 for postoperative respiratory failure, 114.9 for postoperative sepsis, 29.5 for postoperative hemorrhage/hematoma, 5.6 for central-line blood stream infection, 3.5 for accidental puncture/laceration, and 0.7 for iatrogenic pneumothorax. Compared with white patients, Black and Hispanic patients had significantly greater odds in 5 of 7 PDIs; the largest disparities occurred in postoperative sepsis (adjusted odds ratio, 1.55 [1.38-1.73]) for Black patients and postoperative respiratory failure (adjusted odds ratio, 1.34 [1.21-1.49]) for Hispanic patients. Compared with privately insured patients, Medicaid-covered patients had significantly greater odds in 4 of 7 PDIs; the largest disparity occurred in postoperative sepsis (adjusted odds ratios, 1.45 [1.33-1.59]). Stratified analyses demonstrated persistent disparities by race and ethnicity, even among privately insured children. CONCLUSIONS Disparities in safety events were identified for Black and Hispanic children, indicating a need for targeted interventions to improve patient safety in the hospital.
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Affiliation(s)
- Kavita Parikh
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | | | - Gabrina Dixon
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Maranda C Ward
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Pamela S Hinds
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Monika K Goyal
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | | | - Glenn Flores
- Department of Pediatrics, University of Miami Miller School of Medicine, and Holtz Children's Hospital, Jackson Health System, Miami, Florida
| | - Sunitha V Kaiser
- University of California, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, San Francisco, California
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24
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Amdani S, Gossett JG, Chepp V, Urschel S, Asante-Korang A, Dalton JE. Review on clinician bias and its impact on racial and socioeconomic disparities in pediatric heart transplantation. Pediatr Transplant 2024; 28:e14704. [PMID: 38419391 DOI: 10.1111/petr.14704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/18/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
This expert review seeks to highlight implicit bias in health care, transplant medicine, and pediatric heart transplantation to focus attention on the role these biases may play in the racial/ethnic and socioeconomic disparities noted in pediatric heart transplantation. This review breaks down the transplant decision making process to highlight points at which implicit bias may affect outcomes and discuss how the science of human decision making may help understand these complex processes.
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Affiliation(s)
- Shahnawaz Amdani
- Children's Institute Department of Heart, Vascular & Thoracic, Division of Cardiology & Cardiovascular Medicine, Cleveland, Ohio, USA
| | - Jeffrey G Gossett
- Northwell, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - Valerie Chepp
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Simon Urschel
- Division of Pediatric Cardiology at the University of Alberta, Edmonton, Alberta, Canada
| | - Alfred Asante-Korang
- Division of Pediatric Cardiology, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Jarrod E Dalton
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
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25
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Frankenberger WD, Zorc JJ, Ten Have ED, Brodecki D, Faig WG. Triage Accuracy in Pediatrics Using the Emergency Severity Index. J Emerg Nurs 2024; 50:207-214. [PMID: 38099907 DOI: 10.1016/j.jen.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/01/2023] [Accepted: 11/11/2023] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Although the Emergency Severity Index is the most widely used tool in the United States to prioritize care for patients who seek emergency care, including children, there are significant deficiencies in the tool's performance. Inaccurate triage has been associated with delayed treatment, unnecessary diagnostic testing, and bias in clinical care. We evaluated the accuracy of the Emergency Severity Index to stratify patient priority based on predicted resource utilization in pediatric emergency department patients and identified covariates influencing performance. METHODS This cross-sectional, retrospective study used a data platform that links clinical and research data sets from a single freestanding pediatric hospital in the United States. Chi-square analysis was used to describes rates of over- and undertriage. Mixed effects ordinal logistic regression identified associations between Emergency Severity Index categories assigned at triage and key emergency department resources using discrete data elements and natural language processing of text notes. RESULTS We analyzed 304,422 emergency department visits by 153,984 unique individuals in the final analysis; 80% of visits were triaged as lower acuity Emergency Severity Index levels 3 to 5, with the most common level being Emergency Severity Index 4 (43%). Emergency department visits scored Emergency Severity Index levels 3 and 4 were triaged accurately 46% and 38%, respectively. We noted racial differences in overall triage accuracy. DISCUSSION Although the plurality of patients was scored as Emergency Severity Index 4, 50% were mistriaged, and there were disparities based on race indicating Emergency Severity Index mistriages pediatric patients. Further study is needed to elucidate the application of the Emergency Severity Indices in pediatrics using a multicenter emergency department population with diverse clinical and demographic characteristics.
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Dickson CA, Ergun-Longmire B, Greydanus DE, Eke R, Giedeman B, Nickson NM, Hoang LN, Adabanya U, Payares DVP, Chahin S, McCrary J, White K, Moon JH, Haitova N, Deleon J, Apple RW. Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon). Dis Mon 2024; 70:101631. [PMID: 37739834 DOI: 10.1016/j.disamonth.2023.101631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
This is an analysis of important aspects of health equity in caring for children and adolescents written by a multidisciplinary team from different medical centers. In this discussion for clinicians, we look at definitions of pediatric health equity and the enormous impact of social determinants of health in this area. Factors involved with pediatric healthcare disparities that are considered include race, ethnicity, gender, age, poverty, socioeconomic status, LGBT status, living in rural communities, housing instability, food insecurity, access to transportation, availability of healthcare professionals, the status of education, and employment as well as immigration. Additional issues involved with health equity in pediatrics that are reviewed will include the impact of the COVID-19 pandemic, behavioral health concepts, and the negative health effects of climate change. Recommendations that are presented include reflection of one's own attitudes on as well as an understanding of these topics, consideration of the role of various healthcare providers (i.e., community health workers, peer health navigators, others), the impact of behavioral health integration, and the need for well-conceived curricula as well as multi-faceted training programs in pediatric health equity at the undergraduate and postgraduate medical education levels. Furthermore, ongoing research in pediatric health equity is needed to scrutinize current concepts and stimulate the development of ideas with an ever-greater positive influence on the health of our beloved children. Clinicians caring for children can serve as champions for the optimal health of children and their families; in addition, these healthcare professionals are uniquely positioned in their daily work to understand the drivers of health inequities and to be advocates for optimal health equity in the 21st century for all children and adolescents.
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Affiliation(s)
- Cheryl A Dickson
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Berrin Ergun-Longmire
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Donald E Greydanus
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ransome Eke
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Bethany Giedeman
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Nikoli M Nickson
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Department of Psychology, Western Michigan University, Kalamazoo, MI, United States
| | - Uzochukwu Adabanya
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Daniela V Pinto Payares
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Summer Chahin
- Department of Psychology, C.S. Mott Children's Hospital/Michigan Medicine, Ann Arbor, MI, United States
| | - Jerica McCrary
- Center for Rural Health and Health Disparities, Mercer University School of Medicine, Columbus, GA, United States
| | - Katie White
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Jin Hyung Moon
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Nizoramo Haitova
- Department of Educational Leadership, Research and Technology, Western Michigan University, Kalamazoo, MI, United States
| | - Jocelyn Deleon
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Roger W Apple
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
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Totapally BR, Martinez PA, Sendi P, Sachdeva R. Racial Inequities in Mortality Rate in Hospitalized Children. J Natl Med Assoc 2024; 116:56-69. [PMID: 38151422 DOI: 10.1016/j.jnma.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/16/2023] [Accepted: 12/03/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Racial/ethnic inequities for inpatient mortality in children at a national level in the U.S. have not been explored. The objective of this study was to evaluate differences in inpatient mortality rate among different racial/ethnic groups, using the Kids' Inpatient Database. METHODS A cross-sectional study of children of ages greater than 28 days and less than 21 years discharged during 2012 and 2016. Racial/ethnic groups - White, Black, Hispanic, Asian and Pacific Islander and Native Americans were analyzed in two cohorts, Cohort A (all discharges) and Cohort B (ventilated children). RESULTS A total of 4,247,604 and 79,116 discharges were included in cohorts A and B, respectively. Univariate analysis showed that the inpatient mortality rate was highest among Asian and Pacific Islander children for both cohorts: A (0.47% [0.42-0.51]), B (10.9% [9.8-12.1]). Regression analysis showed that Asian and Pacific Islander and Black children had increased odds of inpatient mortality compared to White children: A (1.319 [1.162-1.496], 1.178 [1.105-1.257], respectively) and B (1.391 [1.199-1.613], 1.163 [1.079-1.255], respectively). Population-based hospital mortality was highest in Black children (1.17 per 10,000 children). CONCLUSIONS Inpatient mortality rates are significantly higher in U.S. children of Asian and Pacific Islander and Black races compared to White children. U.S. population-based metrics such as hospitalization rate, ventilation rate, and hospital mortality rate are highest in Black children. Our data suggest that lower median household income alone may not account for a higher inpatient mortality rate. The causes and prevention of racial and ethnic inequities in hospitalized children need to be explored further.
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Affiliation(s)
- Balagangadhar R Totapally
- Division of Critical Care Medicine, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, United States; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199. United States.
| | - Paul A Martinez
- Division of Critical Care Medicine, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, United States; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199. United States
| | - Prithvi Sendi
- Division of Critical Care Medicine, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, United States; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199. United States
| | - Ramesh Sachdeva
- Division of Critical Care Medicine, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, United States; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199. United States
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28
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Orr CJ, Leslie LK, Schaechter J, Williams XJ, Montez KG, Deen JF, Evans YN, Russell CJ, Webb J, Gaona AR, Mendoza FS. Diversity, Equity, and Inclusion, Child Health, and the Pediatric Subspecialty Workforce. Pediatrics 2024; 153:e2023063678S. [PMID: 38300010 PMCID: PMC10852199 DOI: 10.1542/peds.2023-063678s] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Using multiple metrics, the diversity of the pediatric population in the United States is increasing. However, recent data suggest significant disparities in both the prevalence and management of child health conditions cared for by pediatric subspecialists. These inequities occur across multiple dimensions of diversity, including race and ethnicity, country of origin, socioeconomic status, sex and gender, and disability. Research also suggests that attending to diversity, equity, and inclusion in the medical workforce may positively affect health outcomes. High-quality pediatric subspecialty care thus requires knowledge of these data, attention to the effects of social drivers, including racism and discrimination, on health and wellbeing, and interventions to improve pediatric health equity through educational, practice, policy, and research innovations. In this article, we review data on the diversity of the pediatric population and pediatric subspecialty workforce, suggest potential strengths, weaknesses, opportunities, and threats of current diversity, equity, and inclusion initiatives in academic pediatrics, and provide recommendations across 4 domains: education and training, practice, policy, and future research. The ultimate goal of pediatrics is to improve health equity for all infants, children, adolescents, and young adults cared for in the United States by pediatric subspecialists.
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Affiliation(s)
- Colin J. Orr
- Department of Pediatrics
- Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Kimberly G. Montez
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jason F. Deen
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Yolanda N. Evans
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | | | - Jonathan Webb
- American Board of Pediatrics, Chapel Hill, North Carolina
- Association of Women’s Health Obstetric and Neonatal Nurses, Washington, District of Columbia
| | | | - Fernando S. Mendoza
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, California
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29
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Jindal M, Barnert E, Chomilo N, Gilpin Clark S, Cohen A, Crookes DM, Kershaw KN, Kozhimannil KB, Mistry KB, Shlafer RJ, Slopen N, Suglia SF, Nguemeni Tiako MJ, Heard-Garris N. Policy solutions to eliminate racial and ethnic child health disparities in the USA. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:159-174. [PMID: 38242598 PMCID: PMC11163982 DOI: 10.1016/s2352-4642(23)00262-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 01/21/2024]
Abstract
Societal systems act individually and in combination to create and perpetuate structural racism through both policies and practices at the local, state, and federal levels, which, in turn, generate racial and ethnic health disparities. Both current and historical policy approaches across multiple sectors-including housing, employment, health insurance, immigration, and criminal legal-have the potential to affect child health equity. Such policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. Policy efforts that do not directly address structural racism will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism. In Paper 2 of this Series, we build on Paper 1's summary of existing disparities in health-care delivery and highlight policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improve the health of racially and ethnically minoritised children.
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Affiliation(s)
- Monique Jindal
- Department of Medicine, University of Illinois Chicago School of Medicine, Chicago, IL, USA.
| | - Elizabeth Barnert
- Department of Pediatrics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Nathan Chomilo
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Shawnese Gilpin Clark
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alyssa Cohen
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Danielle M Crookes
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA; Department of Sociology and Anthropology, College of Social Sciences and Humanities, Northeastern University, Boston, MA, USA
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katy Backes Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kamila B Mistry
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Office of Extramural Research, Education, and Priority Populations, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD, USA
| | - Rebecca J Shlafer
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, MA, USA; Center on the Developing Child, Harvard University, Boston, MA, USA
| | - Shakira F Suglia
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Nia Heard-Garris
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Institute for Policy Research, Northwestern University, Chicago, IL, USA
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30
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Slopen N, Chang AR, Johnson TJ, Anderson AT, Bate AM, Clark S, Cohen A, Jindal M, Karbeah J, Pachter LM, Priest N, Suglia SF, Bryce N, Fawcett A, Heard-Garris N. Racial and ethnic inequities in the quality of paediatric care in the USA: a review of quantitative evidence. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:147-158. [PMID: 38242597 DOI: 10.1016/s2352-4642(23)00251-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 08/02/2023] [Accepted: 09/08/2023] [Indexed: 01/21/2024]
Abstract
Racial and ethnic inequities in paediatric care have received increased research attention over the past two decades, particularly in the past 5 years, alongside an increased societal focus on racism. In this Series paper, the first in a two-part Series focused on racism and child health in the USA, we summarise evidence on racial and ethnic inequities in the quality of paediatric care. We review studies published between Jan 1, 2017 and July 31, 2022, that are adjusted for or stratified by insurance status to account for group differences in access, and we exclude studies in which differences in access are probably driven by patient preferences or the appropriateness of intervention. Overall, the literature reveals widespread patterns of inequitable treatment across paediatric specialties, including neonatology, primary care, emergency medicine, inpatient and critical care, surgery, developmental disabilities, mental health care, endocrinology, and palliative care. The identified studies indicate that children from minoritised racial and ethnic groups received poorer health-care services relative to non-Hispanic White children, with most studies drawing on data from multiple sites, and accounting for indicators of family socioeconomic position and clinical characteristics (eg, comorbidities or condition severity). The studies discussed a range of potential causes for the observed disparities, including implicit biases and differences in site of care or clinician characteristics. We outline priorities for future research to better understand and address paediatric treatment inequities and implications for practice and policy. Policy changes within and beyond the health-care system, discussed further in the second paper of this Series, are essential to address the root causes of treatment inequities and to promote equitable and excellent health for all children.
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Affiliation(s)
- Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Center on the Developing Child, Harvard University, Boston, MA, USA.
| | - Andrew R Chang
- Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Ashaunta T Anderson
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Aleha M Bate
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Stanely Manne Children's Research Institute, Chicago, IL, USA
| | - Shawnese Clark
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Stanely Manne Children's Research Institute, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alyssa Cohen
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Monique Jindal
- Department of Clinical Medicine, University of Illinois, Chicago, IL, USA
| | - J'Mag Karbeah
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Lee M Pachter
- Institute for Research on Equity and Community Health, ChristianaCare, Wilmington, DE, USA; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; School of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Naomi Priest
- Centre for Social Research and Methods, Australian National University, Canberra, ACT, Australia; Population Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nessa Bryce
- Department of Psychology, Harvard University, Boston, MA, USA
| | - Andrea Fawcett
- Department of Clinical and Organizational Development, Chicago, IL, USA
| | - Nia Heard-Garris
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Department of Pediatrics, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Lyren A, Haines E, Fanta M, Gutzeit M, Staubach K, Chundi P, Ward V, Srinivasan L, Mackey M, Vonderhaar M, Sisson P, Sheffield-Bradshaw U, Fryzlewicz B, Coffey M, Cowden JD. Racial and ethnic disparities in common inpatient safety outcomes in a children's hospital cohort. BMJ Qual Saf 2024; 33:86-97. [PMID: 37460119 DOI: 10.1136/bmjqs-2022-015786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 06/11/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Emerging evidence has shown racial and ethnic disparities in rates of harm for hospitalised children. Previous work has also demonstrated how highly heterogeneous approaches to collection of race and ethnicity data pose challenges to population-level analyses. This work aims to both create an approach to aggregating safety data from multiple hospitals by race and ethnicity and apply the approach to the examination of potential disparities in high-frequency harm conditions. METHODS In this cross-sectional, multicentre study, a cohort of hospitals from the Solutions for Patient Safety network with varying race and ethnicity data collection systems submitted validated central line-associated bloodstream infection (CLABSI) and unplanned extubation (UE) data stratified by patient race and ethnicity categories. Data were submitted using a crosswalk created by the study team that reconciled varying approaches to race and ethnicity data collection by participating hospitals. Harm rates for race and ethnicity categories were compared with reference values reflective of the cohort and broader children's hospital population. RESULTS Racial and ethnic disparities were identified in both harm types. Multiracial Hispanic, Combined Hispanic and Native Hawaiian or other Pacific Islander patients had CLABSI rates of 2.6-3.6 SD above reference values. For Black or African American patients, UE rates were 3.2-4.4 SD higher. Rates of both events in White patients were significantly lower than reference values. CONCLUSIONS The combination of harm data across hospitals with varying race and ethnicity collection systems was accomplished through iterative development of a race and ethnicity category framework. We identified racial and ethnic disparities in CLABSI and UE that can be addressed in future improvement work by identifying and modifying care delivery factors that contribute to safety disparities.
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Affiliation(s)
- Anne Lyren
- Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- UH Rainbow Babies & Children's, Cleveland, Ohio, USA
| | - Elizabeth Haines
- Pediatrics and Emergency Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Hassenfeld Children's Hospital at NYU Langone, New York, New York, USA
| | - Meghan Fanta
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Katherine Staubach
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Pavan Chundi
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Valerie Ward
- Boston Children's Hospital, Boston, Massachusetts, USA
- Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lakshmi Srinivasan
- Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Megan Mackey
- Special Education and Interventions, Central Connecticut State University, New Britain, Connecticut, USA
| | - Michelle Vonderhaar
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Patricia Sisson
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ursula Sheffield-Bradshaw
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Maitreya Coffey
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - John D Cowden
- Department of Pediatrics, Children's Mercy Hospital Kansas, Overland Park, Kansas, USA
- University of Missouri-Kansas City School of Medicine, Kansas, Missouri, USA
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Nogueira LM, Yabroff KR. Climate change and cancer: the Environmental Justice perspective. J Natl Cancer Inst 2024; 116:15-25. [PMID: 37813679 DOI: 10.1093/jnci/djad185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 10/11/2023] Open
Abstract
Despite advances in cancer control-prevention, screening, diagnosis, treatment, and survivorship-racial disparities in cancer incidence and survival persist and, in some cases, are widening in the United States. Since 2020, there's been growing recognition of the role of structural racism, including structurally racist policies and practices, as the main factor contributing to historical and contemporary disparities. Structurally racist policies and practices have been present since the genesis of the United States and are also at the root of environmental injustices, which result in disproportionately high exposure to environmental hazards among communities targeted for marginalization, increased cancer risk, disruptions in access to care, and worsening health outcomes. In addition to widening cancer disparities, environmental injustices enable the development of polluting infrastructure, which contribute to detrimental health outcomes in the entire population, and to climate change, the most pressing public health challenge of our time. In this commentary, we describe the connections between climate change and cancer through an Environmental Justice perspective (defined as the fair treatment and meaningful involvement of people of all racialized groups, nationalities, or income, in all aspects, including development, implementation, and enforcement, of policies and practices that affect the environment and public health), highlighting how the expertise developed in communities targeted for marginalization is crucial for addressing health disparities, tackling climate change, and advancing cancer control efforts for the entire population.
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Affiliation(s)
- Leticia M Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
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Njoroge WFM, Tieu T, Eckardt D, Himes M, Alexandre C, Hall W, Wisniewski K, Popoola A, Holloway K, Rodriguez Y, Kornfield S, Momplaisir F, Wang X, Gur R, Waller R. The impact of the pandemic on mothers and children, with a focus on syndemic effects on black families: the "Prenatal to Preschool" study protocol. Front Psychiatry 2024; 14:1281666. [PMID: 38260788 PMCID: PMC10801187 DOI: 10.3389/fpsyt.2023.1281666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/07/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Racism, a known social determinant of health, affects the mental health and well-being of pregnant and postpartum women and their children. Convincing evidence highlights the urgent need to better identify the mechanisms and the ways in which young children's development and mental health are adversely impacted by their mothers' experiences of racism. With the additional stressor of the COVID-19 pandemic, the criticality of improving knowledge of these domains has never been starker. The proposed project will address these questions and move the field forward to create targeted, culturally informed preventative interventions, thus achieving mental health equity for all children and families. Methods This prospective research is a cohort study that will longitudinally observe the outcomes of a cohort of mothers and their children recruited during the initial phase of the COVID-19 pandemic. Data will be parent/caregiver questionnaires assessing mental health, racism, support, and resilience at multiple time points with the first beginning at 24 months, clinical interviews with mothers, electronic medical records of mothers, and videotaped dyadic interactions at child age 24 and 48 months. A subset of Black participants will be asked to participate in qualitative interviews at child age 36 months. Results Analyze will be performed within and across Black and Non-Latino/a/e/x white (NLW) groups, and comparing mothers and fathers/secondary caregivers. Descriptive and multivariate analyzes will be run to better characterize how young children's development and mental health may be adversely impacted by their caregiver's experiences of racism. Discussion This prospective longitudinal mixed-methods study evaluates the simultaneous effects of the COVID-19 pandemic and racism on mothers and their developing children to characterize cross-racial differences, providing insight into risk and resilience factors in early development and the peripartum period.
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Affiliation(s)
- Wanjikũ F. M. Njoroge
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Tiffany Tieu
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Devlin Eckardt
- Clinical Research Support Office, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Megan Himes
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Christina Alexandre
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Waynitra Hall
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kate Wisniewski
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Ayomide Popoola
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kayla Holloway
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA, United States
| | - Yuheiry Rodriguez
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - Sara Kornfield
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Penn Center for Women’s Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Florence Momplaisir
- Perelman School of Medicine, Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, United States
| | - Xi Wang
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Raquel Gur
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Waller
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
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Gutman CK, Aronson PL, Singh NV, Pickett ML, Bouvay K, Green RS, Roach B, Kotler H, Chow JL, Hartford EA, Hincapie M, St. Pierre-Hetz R, Kelly J, Sartori L, Hoffmann JA, Corboy JB, Bergmann KR, Akinsola B, Ford V, Tedford NJ, Tran TT, Gifford S, Thompson AD, Krack A, Piroutek MJ, Lucrezia S, Chung S, Chowdhury N, Jackson K, Cheng T, Pulcini CD, Kannikeswaran N, Truschel LL, Lin K, Chu J, Molyneaux ND, Duong M, Dingeldein L, Rose JA, Theiler C, Bhalodkar S, Powers E, Waseem M, Lababidi A, Yan X, Lou XY, Fernandez R, Lion KC. Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants. JAMA Pediatr 2024; 178:55-64. [PMID: 37955907 PMCID: PMC10644247 DOI: 10.1001/jamapediatrics.2023.4890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/02/2023] [Indexed: 11/14/2023]
Abstract
Importance Febrile infants at low risk of invasive bacterial infections are unlikely to benefit from lumbar puncture, antibiotics, or hospitalization, yet these are commonly performed. It is not known if there are differences in management by race, ethnicity, or language. Objective To investigate associations between race, ethnicity, and language and additional interventions (lumbar puncture, empirical antibiotics, and hospitalization) in well-appearing febrile infants at low risk of invasive bacterial infection. Design, Setting, and Participants This was a multicenter retrospective cross-sectional analysis of infants receiving emergency department care between January 1, 2018, and December 31, 2019. Data were analyzed from December 2022 to July 2023. Pediatric emergency departments were determined through the Pediatric Emergency Medicine Collaborative Research Committee. Well-appearing febrile infants aged 29 to 60 days at low risk of invasive bacterial infection based on blood and urine testing were included. Data were available for 9847 infants, and 4042 were included following exclusions for ill appearance, medical history, and diagnosis of a focal infectious source. Exposures Infant race and ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White, and other race or ethnicity) and language used for medical care (English and language other than English). Main Outcomes and Measures The primary outcome was receipt of at least 1 of lumbar puncture, empirical antibiotics, or hospitalization. We performed bivariate and multivariable logistic regression with sum contrasts for comparisons. Individual components were assessed as secondary outcomes. Results Across 34 sites, 4042 infants (median [IQR] age, 45 [38-53] days; 1561 [44.4% of the 3516 without missing sex] female; 612 [15.1%] non-Hispanic Black, 1054 [26.1%] Hispanic, 1741 [43.1%] non-Hispanic White, and 352 [9.1%] other race or ethnicity; 3555 [88.0%] English and 463 [12.0%] language other than English) met inclusion criteria. The primary outcome occurred in 969 infants (24%). Race and ethnicity were not associated with the primary composite outcome. Compared to the grand mean, infants of families that use a language other than English had higher odds of the primary outcome (adjusted odds ratio [aOR]; 1.16; 95% CI, 1.01-1.33). In secondary analyses, Hispanic infants, compared to the grand mean, had lower odds of hospital admission (aOR, 0.76; 95% CI, 0.63-0.93). Compared to the grand mean, infants of families that use a language other than English had higher odds of hospital admission (aOR, 1.08; 95% CI, 1.08-1.46). Conclusions and Relevance Among low-risk febrile infants, language used for medical care was associated with the use of at least 1 nonindicated intervention, but race and ethnicity were not. Secondary analyses highlight the complex intersectionality of race, ethnicity, language, and health inequity. As inequitable care may be influenced by communication barriers, new guidelines that emphasize patient-centered communication may create disparities if not implemented with specific attention to equity.
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Affiliation(s)
- Colleen K. Gutman
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville
- Department of Pediatrics, University of Florida College of Medicine, Gainesville
| | - Paul L. Aronson
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nidhi V. Singh
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Kamali Bouvay
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Rebecca S. Green
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School and Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Britta Roach
- Division of Pediatric Emergency Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Hannah Kotler
- Division of Emergency Medicine, The George Washington University School of Medicine and Health Sciences and Children’s National Health System, Washington, DC
| | - Jessica L. Chow
- Division of Emergency Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Emergency Medicine, University of California, Los Angeles
| | - Emily A. Hartford
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle
| | - Mark Hincapie
- Department of Pediatrics, University of Pittsburgh Medical Center and Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- Division of Pediatric Emergency Medicine, Nicklaus Children’s Hospital, Miami, Florida
| | - Ryan St. Pierre-Hetz
- Department of Pediatrics, University of Pittsburgh Medical Center and Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessica Kelly
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Laura Sartori
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer A. Hoffmann
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jacqueline B. Corboy
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kelly R. Bergmann
- Department of Pediatric Emergency Medicine, Children’s Minnesota, Minneapolis, Minnesota
| | - Bolanle Akinsola
- Department of Pediatrics and Emergency Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Vanessa Ford
- Department of Pediatrics and Emergency Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Natalie J. Tedford
- Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City
| | - Theresa T. Tran
- Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City
| | - Sasha Gifford
- Ronald O. Perelman Department of Emergency Medicine/New York University Langone Health, New York, New York
- Department of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Amy D. Thompson
- Department of Pediatrics, Nemours Children’s Hospital of Delaware, Wilmington
| | - Andrew Krack
- Department of Pediatrics, School of Medicine, Section of Emergency Medicine, University of Colorado and Children’s Hospital Colorado, Aurora
| | - Mary Jane Piroutek
- Department of Emergency Medicine, University of California Irvine and Children’s Hospital of Orange County, Orange
| | - Samantha Lucrezia
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
| | - SunHee Chung
- Department of Emergency Medicine, Oregon Health and Science University, Portland
- Department of Pediatrics, Oregon Health and Science University, Portland
| | - Nabila Chowdhury
- Division of Pediatric Emergency Medicine, Johns Hopkins Children’s Center, Baltimore, Maryland
| | - Kathleen Jackson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston
| | - Tabitha Cheng
- Department of Emergency Medicine, Harbor University of California Los Angeles Medical Center and the David Geffen School of Medicine at the University of California, Los Angeles
| | - Christian D. Pulcini
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington
- Department of Emergency Medicine, University of Vermont Larner College of Medicine, Burlington
| | - Nirupama Kannikeswaran
- Department of Pediatrics, Central Michigan University College of Medicine and Children’s Hospital of Michigan, Detroit
| | - Larissa L. Truschel
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Karen Lin
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jamie Chu
- Department of Emergency Medicine, McGovern Medical School, UTHealth Houston, Houston, Texas
- Texas Children’s Pediatrics, Houston
| | - Neh D. Molyneaux
- Department of Emergency Medicine, McGovern Medical School, UTHealth Houston, Houston, Texas
| | - Myto Duong
- Division of Pediatric Emergency Medicine, Southern Illinois University, Carbondale
| | - Leslie Dingeldein
- Rainbow Babies and Children’s Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jerri A. Rose
- Rainbow Babies and Children’s Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Carly Theiler
- Department of Emergency Medicine, University of Iowa, Iowa City
| | - Sonali Bhalodkar
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Emily Powers
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Muhammad Waseem
- Department of Pediatrics, Lincoln Medical Center, Bronx, New York
- Department of Emergency Medicine, Lincoln Medical Center, Bronx, New York
| | - Ahmed Lababidi
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville
- Department of Pediatrics, University of Florida College of Medicine, Gainesville
| | - Xinyu Yan
- Department of Biostatistics, University of Florida College of Medicine and College of Public Health and Health Professions, Gainesville
| | - Xiang-Yang Lou
- Department of Biostatistics, University of Florida College of Medicine and College of Public Health and Health Professions, Gainesville
| | - Rosemarie Fernandez
- Department of Emergency Medicine and the Center for Experiential Learning and Simulation, University of Florida College of Medicine, Gainesville
| | - K. Casey Lion
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
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Katzow MW, Steinway C, Zuzarte A, Chen J, Fishbein J, Jan S. Sociodemographic Disparities in Ambulatory Pediatric Telemedicine Utilization During COVID-19. Telemed J E Health 2024; 30:57-66. [PMID: 37579076 DOI: 10.1089/tmj.2023.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Objective: Few studies have examined sociodemographic disparities in ambulatory pediatric telemedicine utilization during the coronavirus disease 2019 pandemic. We aimed to (1) assess disparities in telemedicine visit completion during the first 6 weeks of the pandemic in 2020 and (2) determine if these disparities were significantly different from those present in 2019, when all visits occurred in person. Methods: We compared sociodemographic characteristics of patients with successful versus unsuccessful telemedicine visits from March 10, 2020 to April 18, 2020, using generalized linear mixed models. We performed the same analysis for in-person visits from the same period in 2019. We tested for differences across years using interaction terms in a combined 2019-2020 model. Results: Of 3,639 telemedicine visits scheduled, 3,033 (83.3%) were successful. In 2020, Black/African American race was significantly associated with lower odds of telemedicine visit success (odds ratio 0.65 [95% confidence interval 0.49-0.87]) compared with White race, after adjusting for age, gender, ethnicity, insurance type, visit timing, visit specialty, social vulnerability index, and internet access. In 2019, racial identity other than White was significantly associated with lower odds of in-person visit success than White, as was public insurance compared with private. In the full 2019-2020 model, in-person visits (2019) had lower odds of success than telemedicine visits (2020), and neither race, insurance type, nor any other sociodemographic characteristic had significant interactions with year. Conclusions: Racial disparities were evident in telemedicine utilization early in the pandemic; however, these disparities were not significantly different from those seen in 2019, when all visits were in person. Furthermore, telemedicine may improve access to care overall, despite having no significant impact on inequity. Efforts to eliminate racial disparities in ambulatory pediatric health care utilization are necessary across visit modalities.
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Affiliation(s)
- Michelle W Katzow
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Center for Health Innovations and Outcomes Research, Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Caren Steinway
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Andrea Zuzarte
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
| | - Jack Chen
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
| | - Joanna Fishbein
- Biostatistics Unit, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Sophia Jan
- Department of Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Center for Health Innovations and Outcomes Research, Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Wentzel S, Craft A, Onwuka A, Lind M. Racial, ethnic and language disparities in healthcare utilization in pediatric patients following tonsillectomy. Int J Pediatr Otorhinolaryngol 2024; 176:111805. [PMID: 38043184 DOI: 10.1016/j.ijporl.2023.111805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/12/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
IMPORTANCE Tonsillectomy is one of the most common surgical procedures performed in the United States. However, there is little known about the intersectionality of race, ethnicity, and language and how these factors influence post-tonsillectomy outcomes such as ED utilization and hospital readmission rates. OBJECTIVE To examine disparities in emergency department (ED) utilization and hospital readmissions for post-tonsillectomy complications based on insurance status, patient race, ethnicity and language spoken. DESIGN This was retrospective cohort over four years. SETTING Tertiary Care Children's Hospital. PARTICIPANTS All children (n = 10,215) who underwent tonsillectomy or adenotonsillectomy at a tertiary children's hospital from January 2015 to December 2018 were identified and included. There were no exclusion criteria. EXPOSURE The exposure of interest was tonsillectomy. MAIN OUTCOMES AND MEASURES Outcomes and variables of interest were defined prior to data collection. The primary outcome of this study was emergency department (ED) utilization defined as any ED or urgent care visit within 21 days of the tonsillectomy for surgery-related concerns. The secondary outcome of this study was readmissions following tonsillectomy. RESULTS A total of 10215 pediatric patients (median age, 6 years; 5096 [50 %] male) who underwent tonsillectomy were included in the analysis. 13 % of patients presented to the ED with surgery-related complaints. Among English proficient patients, multi-racial patients were the only group with an elevated odds of ED utilization (OR:1.5, 95 % CI: 1.2, 1.9). Non-English language preference (NELP) patients of Black, Hispanic, Asian, and American Indian/Alaskan Native race/ethnicity also had elevated odds of ED use post-tonsillectomy compared to non-Hispanic White English proficient patients. Six percent of all patients had an unplanned hospital readmission. Asian patients with non-English language preference had 2.1 times the odds of readmission (95 % CI: 1.2, 3.6); and were disproportionately admitted for post-tonsillectomy hemorrhage. CONCLUSIONS and Relevance: Language disparities in ED use and readmission persist after adjusting for risk factors. Non-English language preference populations have a higher rate of ED utilization, especially for minor complications. Disparities may result from differential health literacy or predispositions to complications. Future directions include additional research on mechanisms and targeted interventions to increase education and access to language-appropriate resources.
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Affiliation(s)
- Stephanie Wentzel
- Medical Student Research Program, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aaron Craft
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Meredith Lind
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Otolaryngology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Alabbadi S, Rowe G, Gill G, Chikwe J, Egorova N. Racial Disparities in Failure to Rescue after Pediatric Heart Surgeries in the US. J Pediatr 2024; 264:113734. [PMID: 37739060 DOI: 10.1016/j.jpeds.2023.113734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE To identify the trend in failure to rescue (FTR) and risk factors contributing to racial disparities in FTR after pediatric heart surgery using contemporary nationwide data. STUDY DESIGN We identified 85 267 congenital heart surgeries in patients <18 years of age from 2009 to 2019 using the Kid's Inpatient Database. The primary outcome was FTR. A mixed-effect logistic regression model with hospital random intercept was used to identify independent predictors of FTR. RESULTS Among 36 753 surgeries with postoperative complications, the FTR was 7.3%. The FTR decreased from 7.4% in 2009 to 6.3% in 2019 (P = .02). FTR was higher among Black than White children for all years. The FTR was higher among girls (7.2%) vs boys (6.6%), children aged <1 (9.6%) vs 12-17 years (2.4%), and those of Black (8.5%) vs White race (5.9%) (all P < .05). Black race was associated with a higher FTR odds (OR, 1.40; 95% CI, 1.20-1.65) after adjusting for demographics, medical complexity, nonelective admission, and hospital surgical volume. Higher hospital volume was associated with a lower odds of FTR for all racial groups, but fewer Black (19.7%) vs White (31%) children underwent surgery at high surgical volume hospitals (P < .001). If Black children were operated on in the same hospitals as White children, the racial differences in FTR would decrease by 47.3%. CONCLUSIONS Racial disparities exist in FTR after pediatric heart surgery in the US. The racial differences in the location of care may account for almost half the disparities in FTR.
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Affiliation(s)
- Sundos Alabbadi
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Georgina Rowe
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - George Gill
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joanna Chikwe
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
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Alizadeh F, Gauvreau K, Mayourian J, Brown E, Barreto JA, Blossom J, Bucholz E, Newburger JW, Kheir J, Vitali S, Thiagarajan RR, Moynihan K. Social Drivers of Health and Pediatric Extracorporeal Membrane Oxygenation Outcomes. Pediatrics 2023; 152:e2023061305. [PMID: 37933403 DOI: 10.1542/peds.2023-061305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Relationships between social drivers of health (SDoH) and pediatric health outcomes are highly complex with substantial inconsistencies in studies examining SDoH and extracorporeal membrane oxygenation (ECMO) outcomes. To add to this literature with emerging novel SDoH measures, and to address calls for institutional accountability, we examined associations between SDoH and pediatric ECMO outcomes. METHODS This single-center retrospective cohort study included children (<18 years) supported on ECMO (2012-2021). SDoH included Child Opportunity Index (COI), race, ethnicity, payer, interpreter requirement, urbanicity, and travel-time to hospital. COI is a multidimensional estimation of SDoH incorporating traditional (eg, income) and novel (eg, healthy food access) neighborhood attributes ([range 0-100] higher indicates healthier child development). Outcomes included in-hospital mortality, ECMO run duration, and length of stay (LOS). RESULTS 540 children on ECMO (96%) had a calculable COI. In-hospital mortality was 44% with median run duration of 125 hours and ICU LOS 29 days. Overall, 334 (62%) had cardiac disease, 92 (17%) neonatal respiratory failure, 93 (17%) pediatric respiratory failure, and 21 (4%) sepsis. Median COI was 64 (interquartile range 32-81), 323 (60%) had public insurance, 174 (34%) were from underrepresented racial groups, 57 (11%) required interpreters, 270 (54%) had urban residence, and median travel-time was 89 minutes. SDoH including COI were not statistically associated with outcomes in univariate or multivariate analysis. CONCLUSIONS We observed no significant difference in pediatric ECMO outcomes according to SDoH. Further research is warranted to better understand drivers of inequitable health outcomes in children, and potential protective mechanisms.
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Affiliation(s)
| | | | | | | | | | - Jeff Blossom
- Center for Geographic Analysis, Harvard University, Cambridge, Massachusetts
| | | | | | - John Kheir
- Departments of Cardiology
- Departments of Pediatrics
| | - Sally Vitali
- Anesthesia, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
- Anesthesia, Harvard Medical School, Boston, Massachusetts
| | | | - Katie Moynihan
- Departments of Cardiology
- Departments of Pediatrics
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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DiFiore G, Wood S, Jenssen BP, Fiks AG, Mayne SL. Cumulative Health Vulnerabilities Among Adolescents by Age and Neighborhood Opportunity. Pediatrics 2023; 152:e2023062657. [PMID: 37974515 PMCID: PMC10774653 DOI: 10.1542/peds.2023-062657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Early detection of health vulnerabilities in adolescents is integral to promoting healthy behaviors into adulthood. Our objective was to quantify the prevalence of health vulnerabilities among adolescents and examine differences by age and neighborhood opportunity. METHODS In a cross-sectional analysis of electronic health record data for adolescents aged 13 to 18 years with preventive visits in a large pediatric primary care network between September 2021 and September 2022, we examined 5 health vulnerabilities: Tobacco use, substance use, firearm access, condomless intercourse, and depressive symptoms. Health vulnerabilities were assessed via self-reported adolescent health questionnaire and the validated Patient Health Questionnaire-Modified. Prevalence of health vulnerabilities were calculated alone and in combination, and compared by age and by quintile of neighborhood Child Opportunity Index (COI) score. Multivariable logistic regression estimated associations of neighborhood COI with reporting ≥2 health vulnerabilities. RESULTS Among 40 197 adolescents (57.7% aged 13-15 years, 66.3% living in "high"/"very high" COI neighborhoods), 29.7% reported at least 1 health vulnerability and 7.9% reported ≥2 vulnerabilities. Cumulative health vulnerabilities were more prevalent among older adolescents and adolescents from lower opportunity neighborhoods. In adjusted models, lower COI was associated with 65% higher odds of having ≥2 vulnerabilities (odds ratio 1.65, 95% confidence interval 1.43-1.91) compared with adolescents from the highest COI quintile. CONCLUSIONS Understanding the relationship between health vulnerabilities and neighborhood opportunities among adolescents may allow pediatric primary care providers and health systems to offer more tailored community support services and transdiagnostic specialized care navigation to address the health needs of teens with multiple vulnerabilities.
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Affiliation(s)
| | - Sarah Wood
- Clinical Futures and PolicyLab
- The Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P. Jenssen
- Clinical Futures and PolicyLab
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G. Fiks
- Clinical Futures and PolicyLab
- The Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie L. Mayne
- Clinical Futures and PolicyLab
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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Nedved AC, Lee BR, Wirtz A, Monsees E, Burns A, Turcotte Benedict FG, El Feghaly RE. Socioeconomic differences in antibiotic use for common infections in pediatric urgent-care centers-A quasi-experimental study. Infect Control Hosp Epidemiol 2023; 44:2009-2016. [PMID: 37381724 DOI: 10.1017/ice.2023.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To investigate differences in the rate of firstline antibiotic prescribing for common pediatric infections in relation to different socioeconomic statuses and the impact of an antimicrobial stewardship program (ASP) in pediatric urgent-care clinics (PUCs). DESIGN Quasi-experimental. SETTING Three PUCs within a Midwestern pediatric academic center. PATIENTS AND PARTICIPANTS Patients aged >60 days and <18 years with acute otitis media, group A streptococcal pharyngitis, community-acquired pneumonia, urinary tract infection, or skin and soft-tissue infections who received systemic antibiotics between July 2017 and December 2020. We excluded patients who were transferred, admitted, or had a concomitant diagnosis requiring systemic antibiotics. INTERVENTION We used national guidelines to determine the appropriateness of antibiotic choice in 2 periods: prior to (July 2017-July 2018) and following ASP implementation (August 2018-December 2020). We used multivariable regression analysis to determine the odds ratios of appropriate firstline agent by age, sex, race and ethnicity, language, and insurance type. RESULTS The study included 34,603 encounters. Prior to ASP implementation in August 2018, female patients, Black non-Hispanic children, those >2 years of age, and those who self-paid had higher odds of receiving recommended firstline antibiotics for all diagnoses compared to male patients, children of other races and ethnicities, other ages, and other insurance types, respectively. Although improvements in prescribing occurred after implementation of our ASP, the difference within the socioeconomic subsets persisted. CONCLUSIONS We observed socioeconomic differences in firstline antibiotic prescribing for common pediatric infections in the PUCs setting despite implementation of an ASP. Antimicrobial stewardship leaders should consider drivers of these differences when developing improvement initiatives.
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Affiliation(s)
- Amanda C Nedved
- Division of Urgent Care, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Brian R Lee
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- Division of Health Services and Outcomes Research, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Ann Wirtz
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- Department of Pharmacy, Children's Mercy Kansas City, Kansas City, Missouri
| | - Elizabeth Monsees
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- Division of Performance Excellence, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Alaina Burns
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- Department of Pharmacy, Children's Mercy Kansas City, Kansas City, Missouri
| | - Frances G Turcotte Benedict
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- Division of Emergency Medicine, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Rana E El Feghaly
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
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Lenne E, Sun CJ, Klawetter S. An Examination of Power in a Triadic Model of Parent-Child-Pediatrician Relationships Related to Early Childhood Gender Development. JOURNAL OF FAMILY THEORY & REVIEW 2023; 15:662-676. [PMID: 38351982 PMCID: PMC10861221 DOI: 10.1111/jftr.12527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/12/2023] [Indexed: 02/16/2024]
Abstract
In this paper, the authors introduce the Triadic Model of Pediatric Care, an innovative conceptual framework for pediatric practice with transgender and gender diverse children. The Triadic Model of Pediatric Care consists of three experts-pediatricians, primary caregiver(s), and children-who each possess unique insights, knowledge, and decision-making power. This model guides pediatricians to provide gender-affirming care that acknowledges children as experts of their own experience and worthy of bodily autonomy, while also working to ensure primary caregiver(s) have the information and support necessary to provide a safe and nurturing developmental environment for their child. The authors provide a recommendation for how the Triadic Model of Pediatric Care might be applied in a pediatric healthcare setting and conclude with a summary of the model's implications, limitations, and future directions.
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Affiliation(s)
- Eline Lenne
- School of Social Work, Portland State University, Portland, OR, USA
| | - Christina J. Sun
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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42
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Calvert ML, Korgaonkar S, Ramachandran S, Sarver DE. Follow-Up Care After Maltreatment: Sociodemographic Associations With Timeliness in a Southern State. CHILD MALTREATMENT 2023; 28:634-647. [PMID: 36281769 DOI: 10.1177/10775595221134155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Children who experience maltreatment are at elevated risk of developing mental health difficulties. Even so, they often do not receive timely, evidenced-based mental health treatment, which may exacerbate the risk of poor outcomes. This study aims to describe the receipt of timely follow-up care after maltreatment in a southern state with known treatment shortages and aims to identify factors associated with timely follow-up care. We utilized a retrospective cohort design using 2014 Mississippi Medicaid administrative claims data for youth 0-18 years. Prevalence estimates and associations with definite and probable maltreatment (based on recorded age/injury combinations) during inpatient and outpatient healthcare encounters were evaluated. Rates of 30-day maltreatment follow-up with any medical or behavioral health provider were also assessed. Prevalence estimates of definite and probable maltreatment in the eligible study population (N = 324,752) were 0.53% and 3.8%, respectively. Only one-third of identified children received 30-day follow-up. Black and older children as well as children diagnosed with anxiety or depression were more likely to receive 30-day follow-up than younger children, white children, and children without anxiety or depression. Low rates of timely follow-up indicate the need for intentional workflow practices to increase the likelihood of follow-up.
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Affiliation(s)
- Maegan L Calvert
- Department of Psychiatry, Brain Imaging Research Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Siddhi Korgaonkar
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, Oxford, MS, USA
| | - Sujith Ramachandran
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, Oxford, MS, USA
| | - Dustin E Sarver
- Department of Pediatrics, Center for Advancement of Youth, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
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43
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Darling KE, Warnick J, Guthrie KM, Santos M, Jelalian E. Referral to Adolescent Weight Management Interventions: Qualitative Perspectives From Providers. J Pediatr Psychol 2023; 48:815-824. [PMID: 37776204 PMCID: PMC11009491 DOI: 10.1093/jpepsy/jsad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023] Open
Abstract
OBJECTIVE Current guidelines for treatment of obesity in adolescence include screening and referring youth with obesity to appropriate weight management (WM) care. However, prior work has not explored the referral process to adolescent WM programs, especially for youth from lower-income backgrounds, who are at increased risk of obesity and related negative health outcomes. This qualitative study sought to understand pediatricians' current practices regarding referrals to adolescent WM interventions with a focus on adolescents from lower-income backgrounds. METHODS Individual interviews were conducted with 11 medical providers that had referred at least 5 adolescents from low-income backgrounds to WM interventions. Applied thematic analysis was used for data analysis. RESULTS Identified themes included weight-related discussions with adolescents as potentially fraught, as providers want to address weight-related health concerns while being thoughtful about potential harm. Providers also noted varied factors affecting their decision to refer to WM programs, including health implications, perceived motivation of the patient and family, and availability of programs. Providers identified that many families experience shame or guilt around referral to WM. Few themes were identified regarding impact of income on weight-related conversations with adolescents. CONCLUSION Findings were novel in regard to discussions of weight in adolescents with obesity leading to WM referral. Despite being a primary focus of the present study, few themes were identified regarding specific considerations for adolescents from low-income backgrounds. Future clinical research should focus on provider-focused interventions to increase sensitivity regarding weight-related discussions and attention to diversity, equity, and inclusion.
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Affiliation(s)
- Katherine E Darling
- Weight Control and Diabetes Research Center, The Miriam Hospital, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| | - Jennifer Warnick
- Weight Control and Diabetes Research Center, The Miriam Hospital, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| | - Kate M Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, USA
| | - Melissa Santos
- Division of Pediatric Psychology, Connecticut Children’s Medical Center, USA
| | - Elissa Jelalian
- Weight Control and Diabetes Research Center, The Miriam Hospital, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
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44
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Freyleue SD, Arakelyan M, Leyenaar JK. Epidemiology of pediatric hospitalizations at general hospitals and freestanding children's hospitals in the United States: 2019 update. J Hosp Med 2023; 18:908-917. [PMID: 37661338 DOI: 10.1002/jhm.13194] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/01/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND General hospitals (GH) provide inpatient care for the majority of hospitalized children in the United States, yet the majority of hospital pediatrics research is conducted at freestanding children's hospitals. OBJECTIVE Updating a prior 2012 analysis, this study used 2019 data to describe characteristics of pediatric hospitalizations at general and freestanding hospitals in the United States and identify the most common and costly reasons for hospitalization in these settings. DESIGNS, SETTING, AND PARTICIPANTS This study examined hospitalizations in children <18 years using the Healthcare Cost and Utilization Project's 2019 Kids' Inpatient Database, stratifying neonatal and nonneonatal hospital stays. INTERVENTION Not applicable. MAIN OUTCOME AND MEASURES Sociodemographic and clinical differences between hospitalizations at general and freestanding children's hospitals were examined, applying survey weights to generate national estimates. RESULTS There were an estimated 5,263,218 pediatric hospitalizations in 2019, including 3,757,601 neonatal and 1,505,617 nonneonatal hospital stays. Overall, 88.6% (n = 4,661,288) of hospitalizations occurred at GH, including 97.6% of neonatal hospitalizations and 65.9% of nonneonatal hospitalizations. 11.4% (n = 601,930) of hospitalizations occurred at freestanding children's hospitals, including 2.4% (n = 88,313) of neonatal hospitalizations and 34.1% (n = 513,616) of nonneonatal hospitalizations. In total, 98.9% of complicated birth hospitalizations and 66.0% of neonatal nonbirth hospitalizations occurred at GH. Among nonneonatal stays, 85.2% of mental health hospitalizations, 63.5% of medical hospitalizations, and 61.3% of surgical hospitalizations occurred at GH.
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Affiliation(s)
- Seneca D Freyleue
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - Mary Arakelyan
- Department of Pediatrics, Dartmouth Health Children's, Lebanon, New Hampshire, USA
| | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
- Department of Pediatrics, Dartmouth Health Children's, Lebanon, New Hampshire, USA
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Rogo T, Holland S. Impact of health disparity on pediatric infections. Curr Opin Infect Dis 2023; 36:394-398. [PMID: 37466089 DOI: 10.1097/qco.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic highlighted the health disparities among minoritized children due to structural racism and socioeconomic inequalities. This review discusses how health disparities affect pediatric infections and how they can be addressed. RECENT FINDINGS In addition to disparities in healthcare access due to poverty, geography, and English-language proficiency, implicit and explicit bias affects the healthcare quality and subsequent outcomes in children and adolescents with infections. Disparities in clinical trial enrollment affect the generalizability of research findings. Physicians who understand their patients' languages and the contexts of culture and socioeconomic conditions are better equipped to address the needs of specific populations and the health disparities among them. SUMMARY Addressing disparities in pediatric infections requires prioritization of efforts to increase physician workforce diversity in Pediatric Infectious Diseases, as well as education in bias reduction and culturally sensitive clinical practice, in addition to socioeconomic interventions that improve healthcare access, delivery, and outcomes.
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Affiliation(s)
- Tanya Rogo
- Division of Pediatric Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Miller VA, Miller C, Davis SM, Nokoff NJ, Buchanan C, Friedrich EA, Carl A, Strine S, Vogiatzi MG. Information needs and health status in adolescents and young adults with differences of sex development or sex chromosome aneuploidies. J Pediatr Urol 2023; 19:586-595. [PMID: 37308330 DOI: 10.1016/j.jpurol.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION When and how to provide condition-related information to adolescents and young adults (AYAs) with differences of sex development or sex chromosome aneuploidies (DSDs or SCAs) is largely based on anecdotal experience and lacks informed guidance. For AYAs with a DSD or SCA, having accurate information is critical for attaining optimal adjustment and well-being, participating in decision making related to treatment options, and transitioning successfully to adult health care, yet prior studies have focused exclusively on parental perspectives and not on the views of adolescents themselves. OBJECTIVE The objective of this study was to describe unmet information needs in AYAs with a DSD or SCA and examine associations with perceived global health. METHODS Participants were recruited from specialty clinics at Children's Hospital of Philadelphia (n = 20) and Children's Hospital Colorado (n = 60). AYAs ages 12-21 years with a DSD or SCA and a parent completed a survey assessing perceived information needs across 20 topics, importance of those topics, and global health using the PROMIS Pediatric Global Health questionnaire (PGH-7). RESULTS AYAs had diagnoses of Klinefelter syndrome (41%), Turner syndrome (25%), and DSD (26%) and were 16.7 years (SD = 2.56) and 44% female. Parent participants were primarily mothers (81%). AYAs perceived that 48.09% of their information needs were unmet (SD = 25.18, range: 0-100). Parents perceived that 55.31% of AYAs' information needs were unmet (SD = 27.46 range: 5-100). AYAs and parents across conditions reported unmet needs related to information about transition to adult health care, financial support for medical care, and how the condition might affect the AYA's health in the future. While AYA-reported PGH-7 scores were not associated with percentage of AYA unmet information needs, parent-reported PGH-7 scores were (r = -.46, p < .001), such that lower parent-reported global health was associated with higher percentage of AYA unmet information needs. DISCUSSION/CONCLUSION On average, parents and AYAs perceived that half of AYAs' information needs were unmet, and a higher percentage of AYA unmet information needs was associated with lower perceived global health. The frequency of unmet needs in this sample of AYAs reflects an opportunity for improvement in clinical care. Future research is needed to understand how education to children and AYAs unfolds as they mature and to develop strategies to address the information needs of AYAs with a DSD or SCA, promote well-being, and facilitate AYA engagement in their own health care.
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Affiliation(s)
- Victoria A Miller
- Division of Adolescent Medicine, HUB, 3500 Civic Center Blvd., Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Christina Miller
- Graduate Program in Genetic Counseling, University of Colorado Anschutz Medical Campus, 13001 East 17th Place, W5107, Aurora, CO, 80045, USA
| | - Shanlee M Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO, 80045, USA
| | - Natalie J Nokoff
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO, 80045, USA
| | - Cindy Buchanan
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO, 80045, USA
| | - Elizabeth A Friedrich
- Division of Adolescent Medicine, HUB, 3500 Civic Center Blvd., Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Alexandra Carl
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, 13123 East 16th Ave., Aurora, CO, 80045, USA
| | - Sophia Strine
- Division of Endocrinology and Diabetes, HUB, 3500 Civic Center Blvd., Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Maria G Vogiatzi
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Endocrinology and Diabetes, HUB, 3500 Civic Center Blvd., Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
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Cook NE, Kissinger-Knox A, Iverson IA, Liu BC, Gaudet CE, Norman MA, Iverson GL. Social Determinants of Health and Health Equity in the Diagnosis and Management of Pediatric Mild Traumatic Brain Injury: A Content Analysis of Research Underlying Clinical Guidelines. J Neurotrauma 2023; 40:1977-1989. [PMID: 37071186 PMCID: PMC10541940 DOI: 10.1089/neu.2023.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
We conducted a content analysis of the literature underlying the Centers for Disease Control and Prevention (CDC) Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children (i.e., the "Guideline") to determine the extent to which social determinants of health (SDoH) were examined or addressed. The systematic review forming the basis for the Guideline included 37 studies addressing diagnosis, prognosis, and treatment/rehabilitation. We examined those studies to identify SDoH domains derived from the U.S. Department of Health and Human Services' Healthy People 2020 and 2030 websites. No study explicitly mentioned "social determinants of health," by name, and few studies addressed SDoH domains as a primary focus (ranging from 0% to 27% of studies across SDoH domains). The most frequently represented SDoH domains, described in an inferential or a descriptive manner, were Education Access and Quality (29.7% of studies), Social and Community Context (27.0% of studies), and Economic Stability (21.6% of studies). Health Care Access (13.5% of studies) was less well represented and no studies (0%) examined Neighborhood and Built Environment. In terms of the CDC clinical questions, SDoH were only examined as predictors of outcome (prognosis) and no studies examined SDoH in relation to diagnosis or treatment/rehabilitation. The Guideline includes some commentary on health literacy and socioeconomic status. Overall, social determinants of health are largely unrepresented as important or meaningful variables influencing the Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children, or in the studies that informed the Guideline.
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Affiliation(s)
- Nathan E. Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Waltham, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Ila A. Iverson
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian C. Liu
- MassGeneral Hospital for Children Sports Concussion Program, Waltham, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Charles E. Gaudet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Waltham, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Marc A. Norman
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, California, USA
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Waltham, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Shoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
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Sborov KD, Haruno LS, Raszka S, Poon SC. Racial and Ethnic Disparities in Pediatric Musculoskeletal Care. Curr Rev Musculoskelet Med 2023; 16:488-492. [PMID: 37548870 PMCID: PMC10497489 DOI: 10.1007/s12178-023-09860-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE OF REVIEW This article provides a review of recent published research studying racial, ethnic, and socioeconomic disparities in pediatric musculoskeletal care. RECENT FINDINGS Disparities in pediatric musculoskeletal care are demonstrated in two general realms: access to care and health outcomes. Though initiatives have been proposed or enacted to address disparities, underrepresented minorities and patients from lower socioeconomic statuses continue to face barriers across the spectrum of orthopedic care and poorer ultimate outcomes after both non-operative and operative management. Minority pediatric patients and those from lower socioeconomic statuses experience delays across the spectrum of orthopedic care for both urgent and non-urgent conditions. They wait longer between injury date and initial orthopedic evaluation, longer to receipt of diagnostic imaging, and longer to ultimate treatment than their counterparts. When finally able to obtain musculoskeletal care and treatment, they are at higher risk of poor in-hospital outcomes and inpatient complications, worse patient reported outcomes, and suboptimal pain management. In the outpatient setting, they receive less physical therapy and follow-up clinic visits, resulting in greater stiffness and strength deficits, and are ultimately less likely to meet return to sport criteria.
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Affiliation(s)
- Katherine D. Sborov
- Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, USA
| | - Lee S. Haruno
- Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, USA
| | - Samuel Raszka
- Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, USA
| | - Selina C. Poon
- Shriners Children’s Southern California, 909 S. Fair Oaks Ave, Pasadena, CA 91105 USA
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Savage TJ, Kronman MP, Sreedhara SK, Lee SB, Oduol T, Huybrechts KF. Treatment Failure and Adverse Events After Amoxicillin-Clavulanate vs Amoxicillin for Pediatric Acute Sinusitis. JAMA 2023; 330:1064-1073. [PMID: 37721610 PMCID: PMC10509725 DOI: 10.1001/jama.2023.15503] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/26/2023] [Indexed: 09/19/2023]
Abstract
Importance Acute sinusitis is one of the most common indications for antibiotic prescribing in children, with an estimated 4.9 million such prescriptions in the US annually. Consensus does not exist regarding the optimal empirical antibiotic. Objective To compare amoxicillin-clavulanate vs amoxicillin for the treatment of acute sinusitis in outpatient children. Design, Setting, and Participants Cohort study of children and adolescents aged 17 years or younger with a new outpatient diagnosis of acute sinusitis and a same-day new prescription dispensation of amoxicillin-clavulanate or amoxicillin in a nationwide health care utilization database. Propensity score matching was used to mitigate confounding. Exposure A new prescription dispensation of amoxicillin-clavulanate or amoxicillin. Main Outcomes and Measures Treatment failure, defined as an aggregate of a new antibiotic dispensation, emergency department or inpatient encounter for acute sinusitis, or inpatient encounter for a sinusitis complication, was assessed 1 to 14 days after cohort enrollment. Adverse events were evaluated, including gastrointestinal symptoms, hypersensitivity and skin reactions, acute kidney injury, and secondary infections. Results The cohort included 320 141 patients. After propensity score matching, there were 198 942 patients (99 471 patients per group), including 100 340 (50.4%) who were female, 101 726 (51.1%) adolescents aged 12 to 17 years, 52 149 (26.2%) children aged 6 to 11 years, and 45 067 (22.7%) children aged 0 to 5 years. Treatment failure occurred in 1.7% overall; 0.01% had serious failure (an emergency department or inpatient encounter). There was no difference in the risk of treatment failure between the amoxicillin-clavulanate and amoxicillin groups (relative risk [RR], 0.98 [95% CI, 0.92-1.05]). The risk of gastrointestinal symptoms (RR, 1.15 [95% CI, 1.05-1.25]) and yeast infections (RR, 1.33 [95% CI, 1.16-1.54]) was higher with amoxicillin-clavulanate. After patients were stratified by age, the risk of treatment failure after amoxicillin-clavulanate was an RR of 0.98 (95% CI, 0.86-1.12) for ages 0 to 5 years; RR was 1.06 (95% CI, 0.92-1.21) for 6 to 11 years; and RR was 0.87 (95% CI, 0.79-0.95) for 12 to 17 years. The age-stratified risk of adverse events after amoxicillin-clavulanate was an RR of 1.23 (95% CI, 1.10-1.37) for ages 0 to 5 years; RR was 1.19 (95% CI, 1.04-1.35) for 6 to 11 years; and RR was 1.04 (95% CI, 0.95-1.14) for 12 to 17 years. Conclusions and Relevance In children with acute sinusitis who were treated as outpatients, there was no difference in the risk of treatment failure between those who received amoxicillin-clavulanate compared with amoxicillin, but amoxicillin-clavulanate was associated with a higher risk of gastrointestinal symptoms and yeast infections. These findings may help inform decisions for empirical antibiotic selection in acute sinusitis.
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Affiliation(s)
- Timothy J. Savage
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Matthew P. Kronman
- Division of Infectious Diseases, Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington
| | - Sushama Kattinakere Sreedhara
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Theresa Oduol
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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50
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Jenkins PC, Lin A, Ames SG, Newgard CD, Lang B, Winslow JE, Marin JR, Cook JNB, Goldhaber-Fiebert JD, Papa L, Zonfrillo MR, Hansen M, Wall SP, Malveau S, Kuppermann N. Emergency Department Pediatric Readiness and Disparities in Mortality Based on Race and Ethnicity. JAMA Netw Open 2023; 6:e2332160. [PMID: 37669053 PMCID: PMC10481245 DOI: 10.1001/jamanetworkopen.2023.32160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/27/2023] [Indexed: 09/06/2023] Open
Abstract
Importance Presentation to emergency departments (EDs) with high levels of pediatric readiness is associated with improved pediatric survival. However, it is unclear whether children of all races and ethnicities benefit equitably from increased levels of such readiness. Objective To evaluate the association of ED pediatric readiness with in-hospital mortality among children of different races and ethnicities with traumatic injuries or acute medical emergencies. Design, Setting, and Participants This cohort study of children requiring emergency care in 586 EDs across 11 states was conducted from January 1, 2012, through December 31, 2017. Eligible participants included children younger than 18 years who were hospitalized for an acute medical emergency or traumatic injury. Data analysis was conducted between November 2022 and April 2023. Exposure Hospitalization for acute medical emergency or traumatic injury. Main Outcomes and Measures The primary outcome was in-hospital mortality. ED pediatric readiness was measured through the weighted Pediatric Readiness Score (wPRS) from the 2013 National Pediatric Readiness Project assessment and categorized by quartile. Multivariable, hierarchical, mixed-effects logistic regression was used to evaluate the association of race and ethnicity with in-hospital mortality. Results The cohort included 633 536 children (median [IQR] age 4 [0-12] years]). There were 557 537 children (98 504 Black [17.7%], 167 838 Hispanic [30.1%], 311 157 White [55.8%], and 147 876 children of other races or ethnicities [26.5%]) who were hospitalized for acute medical emergencies, of whom 5158 (0.9%) died; 75 999 children (12 727 Black [16.7%], 21 604 Hispanic [28.4%], 44 203 White [58.2%]; and 21 609 of other races and ethnicities [27.7%]) were hospitalized for traumatic injuries, of whom 1339 (1.8%) died. Adjusted mortality of Black children with acute medical emergencies was significantly greater than that of Hispanic children, White children, and of children of other races and ethnicities (odds ratio [OR], 1.69; 95% CI, 1.59-1.79) across all quartile levels of ED pediatric readiness; but there were no racial or ethnic disparities in mortality when comparing Black children with traumatic injuries with Hispanic children, White children, and children of other races and ethnicities with traumatic injuries (OR 1.01; 95% CI, 0.89-1.15). When compared with hospitals in the lowest quartile of ED pediatric readiness, children who were treated at hospitals in the highest quartile had significantly lower mortality in both the acute medical emergency cohort (OR 0.24; 95% CI, 0.16-0.36) and traumatic injury cohort (OR, 0.39; 95% CI, 0.25-0.61). The greatest survival advantage associated with high pediatric readiness was experienced for Black children in the acute medical emergency cohort. Conclusions and Relevance In this study, racial and ethnic disparities in mortality existed among children treated for acute medical emergencies but not traumatic injuries. Increased ED pediatric readiness was associated with reduced disparities; it was estimated that increasing the ED pediatric readiness levels of hospitals in the 3 lowest quartiles would result in an estimated 3-fold reduction in disparity for pediatric mortality. However, increased pediatric readiness did not eliminate disparities, indicating that organizations and initiatives dedicated to increasing ED pediatric readiness should consider formal integration of health equity into efforts to improve pediatric emergency care.
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Affiliation(s)
- Peter C. Jenkins
- Department of Surgery, Indiana University School of Medicine, Indianapolis
| | - Amber Lin
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland
| | - Stefanie G. Ames
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Craig D. Newgard
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland
| | - Benjamin Lang
- Department of Pediatrics, Dell Medical School, University of Texas at Austin
- Department of Surgery, Dell Medical School, University of Texas at Austin
| | - James E. Winslow
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- North Carolina Office of Emergency Medical Services, Raleigh
| | - Jennifer R. Marin
- Departments of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jennifer N. B. Cook
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland
| | - Jeremy D. Goldhaber-Fiebert
- Centers for Health Policy, Primary Care, and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Linda Papa
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida
| | - Mark R. Zonfrillo
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Matthew Hansen
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland
| | - Stephen P. Wall
- Ronald O. Perelman Department of Emergency Medicine, Department of Population Health, New York University School of Medicine, New York, New York
| | - Susan Malveau
- Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento
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