97 - Systematic Review of the Impact of Inpatient Pediatric Quality Improvement Interventions on Health Disparities

Poster Number: 97
Publication Number: 97.211

Sarah Schechter, Columbia University Vagelos College of Physicians and Surgeons, New York City, NY, United States; Adria Bowles, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Lucky Ding, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Flory L. Nkoy, University of Utah, Sandy, UT, United States; Joel Tieder, University of Washington School of Medicine and Seattle Children's, Seattle, WA, United States; K. Casey Lion, University of Washington School of Medicine, Seattle, WA, United States; Dodi Meyer, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Sunitha V. Kaiser, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Background: Despite national efforts to improve health equity, disparities in pediatric healthcare quality are widespread and persistent. Quality improvement (QI) has the potential to reduce health disparities by standardizing evidence-based care to reduce bias in medical decision-making and by designing interventions to overcome social barriers to health. However, little is known about the extent to which QI interventions achieve this aim.

Objective: In this systematic review, we aim to examine the effect of inpatient pediatric QI interventions on racial and ethnic, language, and socioeconomic status (SES) disparities in health outcomes.

Design/Methods: We systematically searched all records in MEDLINE’s PubMed and Elsevier’s Embase from January 1, 2000 until November 4, 2021. We included observational or randomized/quasi-randomized studies that reported the effects of inpatient pediatric QI initiatives by race and ethnicity, language, or SES (e.g., parental income, parental education, insurance, social determinants of health) (Table 1).

Results: Of the 7,622 articles identified in the initial search, 6,623 were unique records and underwent abstract screening, 140 underwent full text screening, and 19 met final inclusion criteria (Figure 1). The included studies involved a variety of clinical domains, the most common being maternal breastmilk use (n=6), child abuse screening (n=3), and asthma care (n=2). Fifteen of the 19 studies demonstrated baseline disparities, and 80% of those (12 of 15) had evidence of reduced disparities in process or outcome measures after the QI intervention (Table 2). Most of these studies (n=11) involved hospital-centered QI interventions (e.g., standardization of guidelines, electronic medical record changes) that improved process measures, such as rates of head imaging for child abuse. One study involved a QI intervention that engaged both hospital and community partners and eliminated ethnic disparities in an outcome measure, child mortality.Conclusion(s): We found that few pediatric inpatient QI studies measured and reported effects on health disparities, despite their potential to impact them. Of the few published studies included in our review, hospital-focused QI interventions often reduced disparities in process measures. Broader engagement of community partners in a QI intervention led to elimination of ethnic disparities in child mortality. QI is an underutilized approach to improving healthcare equity in the inpatient setting.
Table 1. Criteria for Inclusion
Figure 1. PRISMA Flow Diagram