Year: 2024
Type: article
Abstract: In a recent publication, we describe and quantify disparities in preventable pediatric safety events.1 Using a long-standing convention in health disparities research, we compare outcomes across race and ethnicity groups by benchmarking against those of white patients.2 Because white patients have historically had more social benefits than other groups, we reasoned this approach would help us investigate the drivers related to race and racism.1 However, the practice of benchmarking performance against white patients should be used with caution because it can perpetuate racism in research and practice by erroneously implying that white patients should define the standard for health or that race is a marker for biology that drives outcome differences.2 Although the call to decenter whiteness in disparity research is not new,3 the confluence of factors at play creates ongoing challenges. Additional work is needed to overcome disparities in health outcomes that have been widespread and persistent for over a century. In this commentary, using our recent study as an example, we propose future analyses that integrate antiracist principles with quality improvement (QI) and patient safety standards to better facilitate the design of effective interventions.Antiracist health research is an action-oriented model that promotes interventions to overcome the long-standing social barriers to equitable care that are driven by racial and ethnic social constructs.4 The design and analysis shift from merely understanding patient characteristics to facilitating improvements in structural conditions.4 Antiracist research (1) clarifies the specific role, if any, that race plays in health outcomes; (2) incorporates racism as a structural inequity that can affect patient outcomes; and (3) transcends using race as a proxy by identifying upstream drivers of differences across groups (eg, differential access to health insurance).Although there is overlap, better integration of the antiracist principles into existing QI and safety frameworks can better target the barriers to health equity while improving quality and safety for all patients. Both involve designing, evaluating, and continually adapting interventions that target identified structural barriers experienced by their patients rather than rely on preconceived assumptions on the underlying causes or the effectiveness of interventions. QI approaches often derive interventions from comparison data from the highest-performing group, and patient safety approaches often create system improvements derived from understanding the root causes of a failure. By assuming performance a priori, centering the white experience in analyses obscures this learning. For example, in our updated analysis presented in this article (Table 1), of the 7 pediatric quality indicators (PDIs) we studied in our initial manuscript,1 the best rates were spread across all race and ethnic groups (specifically, for best-performing PDIs, the white group accounted for 2, Black group accounted for 1, Hispanic ethnicity accounted for 1, and Asian or Pacific Islander accounted for 2). In fact, if all groups performed at the rate of the top-performing group, then 754 events could be avoided annually (95% CI, 373-1199). In this way, the drivers leading to top or lowest performance can now be analyzed and better inform the design of effective interventions for all patients.The impact of race and ethnicity on the lived experience of a patient or their family is complex and will never be completely represented in analyses. This is because, in part, race and ethnicity are evolving social constructs, and people may struggle with classifying themselves as a single race or ethnicity construct.3 Despite this limitation, it remains clear that on a larger scale patients’ race and ethnicity are factors associated with serious safety events. However, the way in which they affect safety outcomes appears to differ by group and condition.5 In our example analysis (Table 1) integrating antiracist principles, we demonstrate that PDI performance differs by race and ethnicity when comparing surgical vs medical complications. These differences require a deeper investigation but may be driven by a variety of factors, such as caregiver/cultural preferences, pre-/postsurgery communication, trust in health care providers, access to care, and racist practices.Designing interventions that improve safety outcomes requires a more precise understanding of patient/family lived experiences as they interact with the health care system. The National Institute of Minority Health and Health Disparities Research Framework6 can help answer complex questions highlighted by our results. For example, when compared with surgical outcomes, it is possible that medical complications, such as central line–associated blood stream infections, may be more prone to being bundled with use failures in certain populations because of barriers with interpreter use or experiences of racism. It is important to explore potential drivers, such as access to timely and high-quality care, communication and engagement of patients/families with health care teams, and utilization of standardized safety protocols. It is also important to understand experiences across groups to design, study, and improve equity-focused QI interventions (eg, standardized video interpreter use, postoperative safety checklists).By analyzing data using antiracist principles and decentering the white patient experience, researchers and organizations can make a major step to finally closing the health disparity and quality gap for children. Through broad partnership and innovative methods, integrating antiracist principles could lead to a redesign of national safety models that encourages hospitals to consider and find ways to overcome health and health equity hurdles, such as racism, language barriers, and other social barriers in root-cause analyses and QI work.We acknowledge the contributions of Drs Gabrina Dixon, Monika Goyal, Pamela Hinds, and Shawn Rangel for article review.
Source: PEDIATRICS
Language: English
Subfield: Emergency Medical Services
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
Award: G603790104
OpenAlex ID: W4404968561