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Navigating the Path to Healthcare Equity: Insights From a Quality Improvement Initiative

May 17, 2024

Editor’s Note: Dr. Alex Eaton (he/him) is a first-year resident physician in pediatrics at The Boston Combined Residency Program at Boston Children's Hospital and Boston Medical Center. He is interested in medical education and health disparities research, specifically pediatric pain management in the setting of historic practices of race-based medicine. Alex is planning to pursue a fellowship specializing in pediatric critical care. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

Achieving healthcare equity remains a paramount challenge in the US healthcare system. Despite concerted efforts, disparities that hinder the delivery of quality care to all individuals, especially children of minoritized racial or ethnic groups, persist. Recognizing this, a recent initiative conducted by Asha Payne, MD, Katharine Moore, MHA, and colleagues at Children’s National Hospital aimed to address these clinical disparities. In their data-driven quality improvement project conducted under the guidance of a multidisciplinary working group, they pursued two key objectives:

1) to enhance/improve completion rates of racial demographic data documentation across the institution and

2) to identify, understand, and address disparities in clinical care.

In their article, published this week in Pediatrics (10.1542/peds.2023-063096), the authors share the team’s experiences, challenges, and lessons learned, which serve as exemplars for others committed to advancing healthcare equity.

Goal 1: Enhancing Completeness of Racial Demographic Data

Recognizing the old adage that "what gets measured gets improved," the group first explored the electronic health record to tackle the lack of completeness in the racial demographic data. One must have a robust and accurate data-based representation of a population to properly understand the problem. While we may understand disparity on a structural level, organization of anecdotal shortcomings into useful action steps requires hard data. Through a systematic approach, the research team engaged leadership and enhanced technology to encourage staff to consistently capture racial designations. These efforts resulted in significant improvement with racial demographic data completeness, reaching 95.3% across the institution.

Goal 2: Identifying Clinical Disparities

To identify clinical disparities, the authors adopted a collaborative approach by seeking input from diverse stakeholders (such as clinicians, staff, community members, and hospital leadership). Through facilitated discussions, they prioritized specific areas; for example, making sure that printed discharge instructions are in a patient’s preferred language. Further examples are shared within the article and point to the complex interplay of social determinants of health that impact Children’s National’s (and any hospital’s) ability to meet a fundamental goal: providing high value care to every single patient seen throughout the institution.

Outcomes and Lessons Learned

Children’s National’s journey has yielded valuable insights that can inform similar initiatives elsewhere. Organizational transparency (as evidenced by numerous public forums and soliciting the input of community leaders) emerged as a crucial factor, as did fostering engagement and trust among stakeholders. Progress within this realm relies heavily on institutional support, both in terms of resources and leadership commitment. Finally, the authors found that to make a long-lasting difference, it is essential to embed diversity, equity, and inclusion programs throughout healthcare systems.

Conclusion and Future Directions

Looking ahead, the focus of this team extends beyond data completeness to leveraging the data into addressing systemic challenges and social determinants of health. In the quest for healthcare equity, each institution's journey is unique, yet institutions can learn from the experience of other institutions. By fostering a culture of transparency, garnering institutional support, and embracing collaborative approaches, we can collectively strive toward a future in which disparities in healthcare are effectively addressed.

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