乌鸦传媒

Black and Hispanic pediatric patients treated at hospitals were significantly more likely to experience a number of adverse safety events compared with their white counterparts, according to findings from the 2019 Kids' Inpatient Database, including a 55% higher odds of postoperative sepsis in Black kids and a 34% higher odds of postoperative respiratory failure in Hispanic children.

In this video interview, researcher Kavita Parikh, MD, of George Washington University and Children's National Hospital in Washington, D.C., discusses the study results, which appeared in .

The following is a transcript of her remarks:

Briefly just to describe the work that we did, it was really rooted in understanding that adverse patient safety events harm children, harm families, cost millions of dollars in medical costs, plus all the worry and heartache that goes with your child being in the hospital and having a safety event.

We know that there's mounting evidence and studies that show across medicine various racial and ethnic and payer disparities exist in the U.S. healthcare system. This includes disparities in suboptimal healthcare access screening, insurance coverage, limited access to care, and use of services. What our team really wanted to do was understand what is happening in pediatrics when kids face safety events during a hospitalization or a hospital stay.

Our study objective was to analyze a national sample of pediatric hospitalizations for disparities in pediatric safety events using established metrics that are produced by the Agency of Healthcare Research and Quality called the Pediatric Quality Indicators, or PDIs. Specifically, we aim to identify disparities in these preventable safety events in hospitalized children on the basis of race and ethnicity and payer status.

We did find that that children who are Black and/or Hispanic who were hospitalized in the United States in 2019 were more likely to experience certain safety events. Specifically, these events included postoperative respiratory failure, postoperative sepsis, as well as bloodstream infections. These were in comparison to patients who were white. More specifically though, like in specific areas, we saw that patients who are Black and insured with Medicaid experience the greatest disparities in postoperative sepsis. Then for patients who are Hispanic, they experience the greatest disparity in postoperative respiratory failure.

There were certain safety events that had higher disparities, some that had no disparities, and so we really were interested in sort of theorizing, of course, next steps.

We talk about multiple factors probably driving these disparities and safety events. We talked about structural racism in the United States in the healthcare system. We talked about clinician bias that could happen when a child is cared for in the hospital, staff bias, insufficient cultural responsiveness for families and children who have been hospitalized, communication barriers, health literacy challenges that could exist, and then impaired access to high-quality and timely healthcare. So, many factors could be driving these disparities that we're seeing.

Really, our work moving forward is to take a deeper dive in these areas to begin to understand what could be driving these, ultimately with the goal of developing targeted interventions or processes that could address these disparities.

I think fundamentally it's important because we obviously want good health outcomes for all children at all places. I think for our team, this was a real way to look at safety events that should not happen. I mean, all of these events should not be happening, period, but then really to look at where they are happening and then disparities. We think it's really fundamentally important to be able to then look at hospital-based processes and systems to address these inequities.

Really, for us, we want to move this forward and we want to think about multidimensional, multifaceted strategies to solve this. Our next step is to take a deeper dive in the specific areas of inequities and disparities that we uncovered in pediatric safety events. We're starting some qualitative work to really understand drivers. We really want to look at solutions, protocol, standardization of care, checklists, and other strategies that we can employ that could provide more standardized care for all of the children that are being admitted and hospitalized.

Our team is going to be working on qualitative work, deeper analysis, and then given that work, we're really focusing on a few of the PDIs, a few of these pediatric safety events that were highlighted in our work. Our goal then will be to design, develop, and test different interventions and strategies with key patient and family voices to improve health equity. We really want to partner with families, we want to partner with the providers and the clinicians to really be able to provide solutions.

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