Disparities in Racial, Ethnic, and Payer Groups for Pediatric Safety Events in US Hospitals.

BACKGROUND AND OBJECTIVES: Health care disparities are pervasive, but little is known about disparities in pediatric safety. We analyzed a national sample of hospitalizations to identify disparities in safety events. METHODS: In this population-based, retrospective cohort study of the 2019 Kids' Inpatient Database, independent variables were race, ethnicity, and payer. Outcomes were Agency for Healthcare Research and Quality pediatric safety indicators (PDIs). Risk-adjusted odds ratios were calculated using white and private payer reference groups. Differences by payer were evaluated by stratifying race and ethnicity. RESULTS: Race and ethnicity of the 5 243 750 discharged patients were white, 46%; Hispanic, 19%; Black, 15%; missing, 8%; other race/multiracial, 7%, Asian American/Pacific Islander, 5%; and Native American, 1%. PDI rates (per 10 000 discharges) were 331.4 for neonatal blood stream infection, 267.5 for postoperative respiratory failure, 114.9 for postoperative sepsis, 29.5 for postoperative hemorrhage/hematoma, 5.6 for central-line blood stream infection, 3.5 for accidental puncture/laceration, and 0.7 for iatrogenic pneumothorax. Compared with white patients, Black and Hispanic patients had significantly greater odds in 5 of 7 PDIs; the largest disparities occurred in postoperative sepsis (adjusted odds ratio, 1.55 [1.38-1.73]) for Black patients and postoperative respiratory failure (adjusted odds ratio, 1.34 [1.21-1.49]) for Hispanic patients. Compared with privately insured patients, Medicaid-covered patients had significantly greater odds in 4 of 7 PDIs; the largest disparity occurred in postoperative sepsis (adjusted odds ratios, 1.45 [1.33-1.59]). Stratified analyses demonstrated persistent disparities by race and ethnicity, even among privately insured children. CONCLUSIONS: Disparities in safety events were identified for Black and Hispanic children, indicating a need for targeted interventions to improve patient safety in the hospital.

Social Risks and Health Care Utilization Among a National Sample of Children With Asthma.

OBJECTIVES: Prior studies using single-center populations have established associations between social risks and health care utilization among children with asthma. We aimed to evaluate associations between social risks and health care utilization among a nationally representative sample of children with asthma. STUDY DESIGN: In this cross-sectional study, we utilized the 2018-2019 National Survey of Children's Health to identify children 2 to 17 years old with asthma. Using the Healthy People (HP) 2030 social determinants of health (SDOH) framework, we identified 31 survey items assessing 18 caregiver-identified social risks as exposure variables and classified them into the 5 HP SDOH domains (Economy, Education, Health care, Community, and Environment). Primary outcome was caregiver-reported health care utilization. Associations between individual social risks and total number of SDOH domains experienced with health care utilization were assessed. RESULTS: The weighted study population included 8.05 million children, 96% of whom reported ≥1 social risk. Fourteen social risks, spanning all 5 SDOH domains, were significantly associated with increased health care utilization. The 3 risks with the highest adjusted odds ratios (aOR) of health care utilization included: experiencing discrimination (aOR 3.26 [95% confidence interval (CI): 1.75, 6.08]); receiving free/reduced lunch (aOR 2.16, [95% CI 1.57, 2.98]); and being a victim of violence (aOR 2.11, [95% CI 1.11, 4]). Children with risks across more SDOH domains reported significantly higher health care utilization. CONCLUSIONS: Among our national population of children with asthma, social risks are prevalent and associated with increased health care utilization, highlighting their potential contribution to pediatric asthma morbidity.

Examining the Association Between MIS-C and the Child Opportunity Index at a Single Center.

OBJECTIVE: To describe associations between the Child Opportunity Index (COI) and multisystem inflammatory syndrome of childhood (MIS-C) diagnosis among hospitalized children. METHODS: We used a retrospective case control study design to examine children ≤21 years hospitalized at a single, tertiary care children's hospital between March 2020 and June 2021. Our study population included children diagnosed with MIS-C (n = 111) and a control group of children hospitalized for MIS-C evaluation who had an alternative diagnosis (n = 61). Census tract COI was the exposure variable, determined using the patient's home address mapped to the census tract. Our outcome measure was MIS-C diagnosis. Odds ratios measured associations between COI and MIS-C diagnosis. RESULTS: Our study population included 111 children diagnosed with MIS-C and 61 children evaluated but ruled out for MIS-C. The distribution of census tract overall COI differed significantly between children diagnosed with MIS-C compared with children with an alternate diagnosis (P = .03). Children residing in census tracts with very low to low overall COI (2.82, 95% confidence interval [CI]: 1.29-6.17) and very low to low health/environment COI (4.69, 95% CI 2.21-9.97) had significantly higher odds of being diagnosed with MIS-C compared with children living in moderate and high to very high COI census tracts, respectively. CONCLUSION: Census tract child opportunity is associated with MIS-C diagnosis among hospitalized children suggesting an important contribution of place-based determinants in the development of MIS-C.

Antiracism in Academic Medicine: Fixing the Leak in the Pipeline of Black Physicians.

Black physicians remain severely underrepresented in academic medicine despite the documented benefits of a diverse medical faculty. Only 3.6% of academic medical faculty self-report as Black or African American. Efforts to improve faculty diversity at academic medical institutions nationwide have not made meaningful impacts. Sustained improvements in faculty diversity cannot be achieved without an actively antiracist approach, including the intentional transformation of policies, practices, and systems that persistently produce worse outcomes for Black medical students, trainees, and faculty.

Diversity, Inclusion and Cultural Competency in Pediatric Hospital Medicine Fellowship Programs.

OBJECTIVES: The objectives with this study were to describe the current state of Pediatric Hospital Medicine (PHM) fellowship programs with regards to (1) diversity of fellows and programs' leadership, (2) current diversity and inclusion (D&I) programs and measures of their success, and (3) the state of cultural competency training. METHODS: In 2018, fellowship directors of the 35 active PHM fellowship programs were invited to participate in a survey of diversity, inclusion, and cultural competency at PHM fellowship programs. Participants were invited via in-person invitations at the annual PHM fellowship directors meeting and through e-mail invitations from July to September to complete an online survey. RESULTS: There was an 89% response rate of the survey. Most fellows, faculty, and program directors in PHM were female (74%, 70%, and 70%, respectively) and white (53%, 67%, and 60%, respectively). There were no African American, American Indian or Alaskan Native, or Native Hawaiian or other Pacific Islander program directors. Forty-five percent of programs reported that neither the fellowship program nor their hospital had a strategic plan that addresses D&I. Approximately 61% of programs had cultural competency training for fellows. CONCLUSIONS: This is the first survey to report on the state of D&I in PHM fellowship programs. There is lack of racial and ethnic diversity in programs fellows, faculty, and directors. Although most programs have cultural competency training, strategic planning to promote D&I is not widely implemented among PHM fellowship programs.

Factors that Influence Underrepresented in Medicine (UIM) Medical Students to Pursue a Career in Academic Pediatrics.

PURPOSE: The purpose of this study was to explore the experiences of medical students who are underrepresented in medicine (UIM) from two urban medical centers with an interest in pursuing academic pediatrics. METHODS: Focus groups were conducted at Children's National Hospital (CN) at three different times with UIM medical students from two urban medical centers. The investigator team was comprised of both junior and senior UIM and non-UIM pediatric academic faculty with experience in qualitative research. Twenty medical students UIM from Howard University College of Medicine (HUCM) and George Washington University School of Medicine and Health Sciences (GWSMHS) participated in the focus groups. The medical students targeted were first, second and fourth years to review experiences pre-and post-third year clerkships. RESULTS: Eighteen of the 20 students completed the demographic data of which 16 identified as Black/African-American. Fifteen of the participants were female and 3 were male. Findings indicated that mentorship, serving as role models, working with children and seeing UIM academic pediatricians positively influenced the students to pursue academic pediatrics. Family had a major influence on students' interest to pursue medicine. A barrier to pursuing academic pediatrics for UIM medical students included educational debt and lack of knowledge about the field. The students felt that there were fewer expectations of them during secondary school years which affected them throughout their journey to medical school. CONCLUSIONS: Early mentorship for UIM medical students is important to increase exposure to academic pediatrics. Future study on the experience of UIM medical students and their pursuit of academic roles could help produce a more diverse workforce. Also, pipeline programs for students to be exposed to academic pediatrics early in their education career would be beneficial.

Factors That Influence the Choice of Academic Pediatrics by Underrepresented Minorities.

OBJECTIVES: Our objective for this study was to explore the experiences of faculty in academic pediatrics who are underrepresented minorities (URMs) at 2 urban medical centers, in particular, the experiences that influenced their pursuit of academic pediatrics. METHODS: Three focus groups were conducted in 2016 with URM faculty from Howard University College of Medicine and Children's National Health System to explore how they were influenced to pursue academic pediatrics. Ten 1-on-1 interviews were also conducted in 2017 with URM faculty at Children's National Health System. Focus groups were coded and analyzed by the research team using standard qualitative methods. The 1-on-1 interviews were coded and analyzed by the primary investigator and verified by members of the research team. RESULTS: A total of 25 faculty participated in the study (15 in the focus groups and 10 in individual interviews). Eighteen of the faculty were women and 7 were men. Findings revealed that mentorship, family, and community influenced participants' career choices. Barriers for URMs in academic pediatrics included (1) lack of other URMs in leadership positions, (2) few URMs practicing academic pediatrics, and (3) the impact of racism and gender and implicit bias in the medical field. CONCLUSIONS: Mentorship and family are major influences on why URMs become academic pediatricians. Lack of URMs in leadership positions, racism, gender bias, and implicit bias are barriers for URMs in academic pediatrics. More research should be conducted on ways to enhance the experience of URMs and to reduce barriers in academia.

Problem Representation, Background Evidence, Analysis, Recommendation: An Oral Case Presentation Tool to Promote Diagnostic Reasoning.

Oral case presentations provide an opportunity for trainees to communicate diagnostic reasoning at the bedside. However, few tools exist to enable faculty to provide effective feedback. We developed a tool to assess diagnostic reasoning and communication during oral case presentations.