PAINED: Project Addressing INequities in the Emergency Department

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Project Abstract Racial and ethnic inequities in health care quality have been described across a broad range of clinical settings, patient populations, and outcomes. Clinician implicit bias has been implicated in the causal pathway for health care disparities. It is now imperative that we target the causes and develop interventions to mitigate and eradicate such inequities. Our overarching goal is to eradicate health care inequities through evidence- based interventions. In response to the RFA-NS-22-002: HEAL Initiative: Advancing Health Equity in Pain Management (R61/R33), the objectives of this proposal are to develop and test the impact of two interventions on overcoming clinician implicit bias and mitigating inequities in the management of pain among children seeking care in the emergency department for the treatment of appendicitis or long bone fractures. The scientific premise stems from our prior work which: 1) demonstrated racial and ethnic inequities in the management of pain for children in the emergency department; 2) examined the role of implicit bias in vignette- based health outcomes; and 3) used audit and feedback and clinical decision support tools to improve performance metrics among clinicians. We will build on this foundational work by measuring the impact of clinician implicit bias among providers and nurses on both process and outcome measures, including the assessment and reduction of pain. We will use a stakeholder-informed approach to identify quality metrics that are patient-centric. We will then test whether regular clinician audit and feedback, through the provision of ‘Equity Report Cards,’ as well as provision of real-time, electronic health record-embedded clinical decision support can serve as useful interventions in mitigating racial/ethnic disparities in clinical outcomes. This research is significant because both interventions can be inexpensively disseminated and scaled to emergency departments nationally as well as to other clinical venues and adapted for various clinical conditions. Through innovative study design and rigorous evaluation, this proposal will provide critical evidence and lay the foundation for eradicating racial and ethnic inequities in the provision of care and improved child health outcomes for all.