It may seem like common sense that every child deserves a fair opportunity to be as healthy as possible, yet studies have shown that patient care experiences can vary based on a child’s race or ethnicity.
Thanks in large part to the generosity of our philanthropic community, Sala Institute for Child and Family Centered Care is helping to break new ground to uncover racial and ethnic biases in pediatric medicine. Its efforts will inform recommendations for overcoming these complex challenges and creating a healthier future for every child.
Defining and Identifying Health Equity
The ultimate goal for every child and family is to receive equitable, personalized, and safe care at the hospital. But what exactly would that look like?
“For example, equal care would make the same educational materials available to patients and families in their preferred language, while equitable care asks what more a patient and family would need to make those materials useful,” explains Elizabeth Haines, DO, MSc, Sala’s director of patient safety and quality. “Maybe it’s meeting with the family at 7 am with an interpreter, before the parents’ workday begins, to explain the information and answer questions. Maybe it’s changing the doctors’ rounds to a time when parents can be present. In true form to equity, it will be figuring out what the best access points are.”
Disrupting Biases through Deeper Analysis
Over the past year, Sala has played a key role in taking the study of health equity to a deeper, more actionable level by focusing on patient safety.
“Our first task was to generate data recognizing that disparities exist in pediatric medicine based on race and ethnicity,” Dr. Haines says. “Now, we’re showing how these disparities play out in patient safety, and we’re working toward interventions designed to strengthen equitable quality, safety, and health outcomes for children and their loved ones.”
Specifically, Dr. Haines and her colleagues have shown that minoritized patients experience disparate outcomes for the most common hospital-acquired, preventable harm conditions, including unplanned extubations and central line associated bloodstream infections (CLABSIs).
Now, we’re showing how these disparities play out in patient safety, and we’re working toward interventions designed to strengthen equitable quality, safety, and health outcomes for children and their loved ones.
Elizabeth Haines, DO, MSc
Director of Patient Safety and Quality, Sala Institute
Uncovering the reasons for these inequities has prompted additional analysis when unplanned extubations or CLABSIs occur at Hassenfeld Children’s Hospital. “Now, at the end of every analysis, we routinely ask about patient and family characteristics, language or cultural barriers, race, ethnicity, and anything else that may have contributed to the disparity of care,” Dr. Haines notes. These standard questions, along with data demonstrating differing rates, have informed new interventions put in place to make care safer.
This more robust analysis of a recent CLABSI revealed that the patient’s religious head covering reduced the informal visual inspections that staff often make when they enter and leave patients’ rooms. Additional analyses revealed that adverse events don’t always occur with the sickest patients; rather, the care team tends to check on patients less frequently when the family speaks a language other than English or when parents’ jobs prevent them from consistently advocating at their child’s bedside.
Therefore, factors like preferred language, parental presence, and religious preference must be evaluated and personalized for each patient. “We need to look deeper into the subtleties of care in our daily interactions that might contribute to disparate harm,” Dr. Haines explains.
Reducing Pediatric Care Inequities Nationwide
These care disparities are not unique to Hassenfeld Children’s Hospital, as data from more than 25 top children’s hospitals in the United States and Canada tell the same story of inequity. With Sala’s leadership, Hassenfeld Children’s Hospital has joined forces with these hospitals to form PHARE (Patient Harm and Relation to Equity), a dynamic group that is exploring widespread inequities in pediatric harm outcomes.
Importantly, Dr. Haines and her PHARE peers will soon publish the first study of its kind on disparate health outcomes. “We discovered with statistical certainty that pediatric patient harm was happening consistently among our hospitals as a result of racial and ethnic biases, and we know that our data is in line with the national data,” she says.
There is important work to be done, and together with the PHARE network, Sala will continue to make significant contributions to NYU Langone Health and our nation’s healthcare system’s ability to provide equitable outcomes for all children.