A novel pilot program to reduce health inequities: A single center's experience with advocacy in pediatric gastroenterology, hepatology and nutrition

ABSTRACT

Background: Health advocacy that ?promotes social, economic, educational and political changes that ameliorate suffering and threats to human health? is an essential component of comprehensive medical care. The COVID-19 pandemic highlighted existing structural health inequities for vulnerable and marginalized populations, bringing greater visibility and urgency for providers to actively assess social determinants of health and address barriers to improve health outcomes. We aimed to create a multidisciplinary team within our pediatric gastroenterology, hepatology and nutrition division to provide comprehensive and equitable subspecialty care to all children regardless of race or ethnicity, gender identity, sexual orientation, socioeconomic status, disability, illness, language or country of origin. We organized our center's novel integrative approach to pediatric gastroenterology (GI) and hepatology-related advocacy into four action domains 1) identify and address social disparities and health inequities;2) improve GI and hepatology programming to increase accessibility to and inclusivity for all patients;3) increase community engagement;and 4) amplify subspecialty related advocacy using innovative social media strategies. Methods: The Stanford University Division of Pediatric Gastroenterology, Hepatology and Nutrition Advocacy Group was established in January 2020 and includes 16 voluntary participants including GI trainees, attending physicians, advanced practice providers, dietitians, social workers and staff. The group relies on active cross collaboration and discussion guided by the founder of the GI advocacy group in partnership with the Associate Chair for Policy & Community Engagement as the department level sponsor. The group participates in one-hour monthly meetings with the first 30 minutes focused on ?think tank? discussions about new and ongoing GI and hepatology advocacy projects. The last 30 minutes includes invited speakers related to a current advocacy project, to provide education on community resources for the diverse patients we serve, or to hone a new skill related to pediatric subspecialty advocacy. Our group communicates between meetings through a designated email listserv and our members share a social media platform (Twitter handle @StanfordPedsGI) to promote division-wide advocacy efforts. Results: The Stanford Pediatric GI Advocacy group has worked to take action on systemic inequities and reduce and eliminate barriers to pediatric healthcare. We will share one example from each of the four action domains. To identify and address social disparities we implemented a universal outpatient social determinants of health screening, adapting the Health Leads' screening toolkit in both English and Spanish. To date we have screened approximately 1,000 patients in clinic. Members of our group helped lead a national workshop for addressing racial bias in pediatric liver transplantation (http//bit.ly/SPLITbiasworkshop), which was sponsored by the Society of Pediatric Liver Transplantation (SPLIT) and attended by leaders in transplant surgery and transplant hepatology across two one-hour sessions. To increase accessibility and inclusivity we created a Spanish language ?COVID Townhall? recording for our liver and intestinal transplant recipients (http//bit.ly/COVIDSpanishtownhall) which has been viewed over 200 times. To increase community engagement we participated in six health-related external service projects providing donations and voluntary assistance to bridge gaps and create connections in our local community. Through these efforts we have collected 30+ pounds of food, 500 children's books to establish GI and hepatology clinic libraries, 200 disposable masks, $500 for a local aquatherapy pool and $600 for aid to families in paying utility bills. Finally, to amplify the need to address these issues we established a group website (http//bit.ly/GIAdvocacy) and launched a Twitter media campaign (https//twitter.com/stanfordpedsgi). The Twitter account has produced 24 tweets with over 30,000 otal impressions, and 1,050 total engagements addressing topics related to child health advocacy in pediatric gastroenterology, hepatology, and nutrition. Conclusion: Over the course of one year, our division demonstrated the feasibility of building a team of GI and hepatology advocates, utilizing the strength of a multidisciplinary collaborative team model to successfully implement short and long-term projects. These projects varied across four domains which contributed to the overall health and wellness of our patients. Child health advocacy is a foundational component of clinical subspecialty practice to ensure equitable care for our pediatric gastroenterology and hepatology patients. Combining the clinical expertise of multiple team members of different disciplines has led to a robust effort to support the well-being and care of our patients.