Detecting and Understanding Disparities in Pediatric Safety Events for Hospitalized Children

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Project Summary/Abstract: Despite decades of focus on reducing medical errors, children continue to suffer substantial harms in hospital settings, and pediatric safety events in hospitals disproportionately affect children of color and those who live in poverty. While there has been work in pediatrics to categorize and address safety events, there is a critical need in our understanding and approaches to eliminate racialized and socio- economic disparities in pediatric safety events. The long-term goal is to ensure equitable care for all hospitalized children. The overall objectives are to leverage existing pediatric safety measures to detect and understand drivers of disparities in select inpatient pediatric safety events. The Chin framework for advancing health equity in patient safety, which is informed by patient and family engagement, will be used, and consists of identifying health disparities, understanding potential mechanisms that drive them, and then designing interventions to eliminate disparities. In direct response to Agency for Healthcare Research and Quality’s (AHRQ) recently released Special Emphasis Notice “Interest in Health Services Research to Advance Health Equity” NOT-HS-21-041, a mixed-methods study to advance the nation’s goal of achieving equity in the delivery of healthcare services by reducing disparities in select pediatric patient safety events is proposed through these two specific aims: 1). Detect disparities in pediatric safety events among hospitalized children by race/ethnicity and/or socioeconomic status. Pediatric safety outcomes will include the AHRQ pediatric quality indicators (PDIs) and adverse medical device event (AMDE) rates in pediatric hospitalizations. Both the Kids’ Inpatient Database and Inpatient Essentials database will be evaluated for disparities in PDIs or ADMEs. 2). Understand mechanisms and identify potential interventions for eliminating racialized and socio-economic disparities in pediatric safety events. Selected pediatric safety events will be identified and in-depth, qualitative analysis via focus groups of hospital staff/clinicians and patients/families will be conducted to identify potential mechanisms of disparities and interventions to address these disparities. This aim will be informed by Flores and Ngui’s comprehensive, patient-and-family centered framework for understanding disparities in pediatric safety events. The research proposed in this application is innovative because the disparities in pediatric safety events will be analyzed using established measures of pediatric safety combined with patient/family engagement to comprehensively understand potential drivers of selected measures. The proposed research is significant because it is expected to provide a more detailed understanding of select disparities in pediatric safety events and identification of potential interventions to address these disparities. These results are expected to have profound positive impact by identifying patient-family centered candidate interventions for addressing specific disparities in pediatric safety for future R01 study. This proposal aligns with AHRQ’s goals and priority population of improving health care quality, safety, and equity in children.