Survey IDs research priorities for addressing disparities in pediatric emergency care
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Key takeaways:
- Researchers surveyed experts to help develop a list of research priorities for addressing disparities in pediatric emergency care.
- The effort identified 12 research priorities that could help guide investigators.
Survey responses from a panel of experts identified 12 research priorities that could help address systemic disparities in pediatric emergency care, according to results published in JAMA Network Open.
One of the study’s authors said she became passionate about disparities in care for patients who speak languages other than English during her medical training.
“It was really sort of fascinating and frustrating to me as I went through medical training that ... folks who have the same illness who live within miles of each other may have really different outcomes,” Elyse N. Portillo, MD, MPH, assistant professor of emergency medicine at Baylor College of Medicine and Texas Children’s Hospital, told Healio.
“Over the last decade or so, there has been a really big uptick in the number of studies investigating disparities, not just in pediatric emergency medicine, but in all types of conditions and specialties,” Portillo said.
“We felt like there wasn’t a clear roadmap for where we needed to go for this field of study, and so we set out to make one,” she said.
Portillo and colleagues assessed a list of 27 research priorities through two rounds of electronic surveys of experts in late 2021 and early 2022. The surveys were completed by family or community and medical or research partners and organizations, with 38 of 47 of these partners (80.6%) completing the survey in round one and 30 of 38 (81.1%) completing it in round two.
The researchers considered a priority as achieving consensus if it was named as such by at least 60% of respondents. They also reached out to nurse practitioners, child life specialists, interpreters, and patient and family advisory boards for input.
“The institutions of medicine have somehow been leaving some folks behind,” Portillo said. “We haven’t been able to be successful with everyone from all sorts of different backgrounds, and so we felt like it was important to incorporate voices from diverse backgrounds, to make sure that we’re taking into consideration not just what’s important to the doctors and to the researchers, but what’s important to our other medical care partners, and what’s important to the patients and the families that we serve.”
Following the two rounds of review, the researchers identified the following 12 research priorities:
- systematic efforts to lessen disparities;
- race, ethnicity, and language data collection and reporting;
- recognizing and mitigating implicit bias of clinicians;
- disparities in mental health;
- social determinants of health;
- language and literacy;
- disparities in acute pain-management;
- care equity metrics quality;
- shared decision-making;
- patient experience;
- triage and acuity score assignment; and
- inclusive research participation.
This list, Portillo said, suggests a research priority agenda that may be used as a guide for investigators.
“We know that disparities exist in this country and in the world in health care,” Portillo said. “As folks are starting any type of project — whether it is a research project [or] a QI initiative in their local practice — we want them to be able to look at this list and see what matters right now.”
A separate multi-center study published in JAMA Pediatrics specifically examined disparities by race, ethnicity and language in low-risk febrile infants, and found that infants of families that use a language other than English had higher odds of hospital admission (adjusted OR = 1.08; 95% CI, 1.08-1.46).
The study was accompanied by a commentary authored by Portillo and Angela Ellison, MD, MSc, a physician at The Children’s Hospital of Philadelphia.
“Miscommunication with our growing population of patients and families who use a language other than English and failure to recognize the need for an interpreter can also cause significant harm to pediatric patients,” Portillo and Ellison wrote. “The groundwork is laid, the blueprint is made, and now it is time to do the work of implementing the identified solutions.”
References:
Gutman D, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2023.4890.
Portillo EN, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.43791.
Portillo EN, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2023.4896.
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