Accountability Through Measurement: Using a Dashboard to Address Pediatric Health Disparities

Hester, Gabrielle; Nickel, Amanda; Griffin, Kristen H.

doi:10.1542/peds.2020-024448

Cited by 14 publications

(15 citation statements)

References 6 publications

(8 reference statements)

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“…Because of the compounding negative, longitudinal effects of health care access and quality inequities, systemic racism and health care discrimination, 13,24 the present results highlight the strong need to conduct actionable programs to support targeted system improvement. For example, emerging evidence indicates feedback loops for communicating biases to the provider, 25 tools to monitor standard care adherence, such as enhanced recovery after surgery protocols, 26 and real-time practice dashboards 27 may reduce outcomes inequities in Black patients compared to White patients. However, there remains a lack of personalized practice improvement tools (eg dashboards) and programs that specifically target health care inequities and create a culture of accountability in the MHS.…”

Section: Discussionmentioning

confidence: 99%

Procedural Benzodiazepine and Post-Vasectomy Opioid and Nonopioid Prescribing Variation in a Large Health Care System

et al. 2022

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Introduction:Our goal was to describe variation in procedural benzodiazepine and post-vasectomy nonopioid pain and opioid prescription dispense events, and multilevel factors associated with the probability of an opioid refill.Methods:Patients (40,584) undergoing vasectomies in the U.S. Military Health System between January 2016–January 2020 were included in this observational retrospective study. The main outcome was the probability of being dispensed an opioid prescription refill within 30 days post-vasectomy. Bivariate analyses examined the relationships between patient- and care-level characteristics, prescription dispense and 30-day opioid prescription refill. A generalized additive mixed-effects model and sensitivity analyses examined factors associated with opioid refill.Results:There was wide variation in procedural benzodiazepine (32%) and post-vasectomy nonopioid (71%) and opioid (73%) prescription dispense patterns across facilities. Only 5% of the patients dispensed opioids received a refill. Probability of an opioid refill was associated with race (White), younger age, opioid dispense history, documented mental health or pain condition, lack of post-vasectomy nonopioid pain medication dispense events and higher dispensed post-vasectomy opioid prescription dose; albeit the effect of dose did not replicate in sensitivity analyses.Conclusions:Despite the wide variation in vasectomy-related pharmacological pathways across a large health care system, most patients do not require an opioid refill. Significant variation in prescribing practices indicated racial inequities. Given the low rates of opioid prescription refill, combined with the wide variation in opioid prescription dispense events and American Urological Association recommendations for conservative opioid prescribing after vasectomy, intervention to address excessive opioid prescribing is warranted.

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Section: Discussionmentioning

confidence: 99%

Procedural Benzodiazepine and Post-Vasectomy Opioid and Nonopioid Prescribing Variation in a Large Health Care System

et al. 2022

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“…Some strategies to encourage robust decision-making as described in the literature are shown (Table 1). These include implementing process-based approaches to decision-making, increasing transparency about shortcomings in healthcare with health equity dashboards, mandatory implicit bias as well as communication skills training, efforts to improve family-centered care provision in PICUs, and ongoing research including efforts to enhance practical implementation of SDM at the bedside (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). • Training and experience are essential for communication around end-of-life decisions (17).…”

Section: Future Directionsmentioning

confidence: 99%

“…These skills are often not intentionally "taught" to trainees but rather "learned" by osmosis' (20). Attending physicians and trainee confidence is inadequate and represents an enormous barrier to timely advanced care planning (18,19) • Trainee programs such as VitalTalk require protected time and funding which is infeasible for many centers (17) necessitating novel approaches to extend the reach • Learning experiences with skills demonstration and interactive role plays with actors, such as the communication course mandated for critical care trainees by The College of Intensive Care Medicine of Australia and New Zealand, are particularly valuable to trainees with less opportunity to refine these skills in real life clinical scenarios • Formal curriculum requirements ideally incorporating simulation, practice repetition, and specific training for mitigation of bias are a step in the right direction to ensuring that the next generation of trainees are armed with the tools to actively participate in SDM and guide families in an ethically permissible way (16,22) Ongoing research and quality improvement efforts to improve family-centered care provision in the PICU…”

Section: Future Directionsmentioning

confidence: 99%

A Nudge or a Shove: The Importance of Balancing Parameters and Training in Decision-Making Communication*

Smith,

Basu,

Moynihan

2024

Pediatric Critical Care Medicine

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“…The patient equity index advances health system e accountability to both its patients and communities in making measurable progress toward eliminating health inequities. It will also help Nemours and its partners better assess where the expertise and experience of the health system can best be brought to bear and where it makes sense to provide support for other community leads [ 45 ▪▪ ].…”

Section: Principles and Tactics For Effective Cross-sector Networkmentioning

confidence: 99%

Moving the needle on health inequities: principles and tactics for effective cross-sector population health networks

Gertel-Rosenberg

Viveiros

Koster

et al. 2021

Current Opinion in Pediatrics

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Purpose of review To summarize elements of cross-sector population health networks to support systems and policy change to achieve equitable access to health services and healthy development opportunities for young children and families, allowing everyone to have a fair and just opportunity to be as healthy as possible. Recent findings The principles and tactics of Equity and Inclusion, Readiness, Joint Planning, Governance, and Data can guide cross-sector networks in effectively supporting communities in addressing health inequities. These principles are not linear or siloed, but rather, they overlap and reinforce each other. The principles require equity and the participation of community members to be central in all aspects of cross-sector network work. Summary By building strong relationships among community partners, cross-sector population health networks can ensure the network is not a short-term, transactional one-time project, but rather, a sustained collaboration through enduring processes and infrastructure. Networks can gain a fuller understanding of the needs and assets of a community through engagement and leadership by community members than they could gather from data and surveys alone. This approach to serving a community by making members equal partners in the effort helps to place equity at the center of a network's focus, as does embedding equity-related decision-making tools and processes into daily operations of the network. If cross-sector networks build resilient, inclusive structures and procedures, they can utilize them to quickly pivot and adjust to emerging needs or respond to crisis.

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Accountability Through Measurement: Using a Dashboard to Address Pediatric Health Disparities

Cited by 14 publications

References 6 publications

Procedural Benzodiazepine and Post-Vasectomy Opioid and Nonopioid Prescribing Variation in a Large Health Care System

Procedural Benzodiazepine and Post-Vasectomy Opioid and Nonopioid Prescribing Variation in a Large Health Care System

A Nudge or a Shove: The Importance of Balancing Parameters and Training in Decision-Making Communication*

Moving the needle on health inequities: principles and tactics for effective cross-sector population health networks

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