Racial and ethnic disparities in common inpatient safety outcomes in a children's hospital cohort.
collaborative, breakthrough groups
paediatrics
patient safety
Journal
BMJ quality & safety
ISSN: 2044-5423
Titre abrégé: BMJ Qual Saf
Pays: England
ID NLM: 101546984
Informations de publication
Date de publication:
17 Jul 2023
17 Jul 2023
Historique:
received:
03
12
2022
accepted:
11
06
2023
medline:
18
7
2023
pubmed:
18
7
2023
entrez:
17
7
2023
Statut:
aheadofprint
Résumé
Emerging evidence has shown racial and ethnic disparities in rates of harm for hospitalised children. Previous work has also demonstrated how highly heterogeneous approaches to collection of race and ethnicity data pose challenges to population-level analyses. This work aims to both create an approach to aggregating safety data from multiple hospitals by race and ethnicity and apply the approach to the examination of potential disparities in high-frequency harm conditions. In this cross-sectional, multicentre study, a cohort of hospitals from the Solutions for Patient Safety network with varying race and ethnicity data collection systems submitted validated central line-associated bloodstream infection (CLABSI) and unplanned extubation (UE) data stratified by patient race and ethnicity categories. Data were submitted using a crosswalk created by the study team that reconciled varying approaches to race and ethnicity data collection by participating hospitals. Harm rates for race and ethnicity categories were compared with reference values reflective of the cohort and broader children's hospital population. Racial and ethnic disparities were identified in both harm types. Multiracial Hispanic, Combined Hispanic and Native Hawaiian or other Pacific Islander patients had CLABSI rates of 2.6-3.6 SD above reference values. For Black or African American patients, UE rates were 3.2-4.4 SD higher. Rates of both events in White patients were significantly lower than reference values. The combination of harm data across hospitals with varying race and ethnicity collection systems was accomplished through iterative development of a race and ethnicity category framework. We identified racial and ethnic disparities in CLABSI and UE that can be addressed in future improvement work by identifying and modifying care delivery factors that contribute to safety disparities.
Sections du résumé
BACKGROUND
BACKGROUND
Emerging evidence has shown racial and ethnic disparities in rates of harm for hospitalised children. Previous work has also demonstrated how highly heterogeneous approaches to collection of race and ethnicity data pose challenges to population-level analyses. This work aims to both create an approach to aggregating safety data from multiple hospitals by race and ethnicity and apply the approach to the examination of potential disparities in high-frequency harm conditions.
METHODS
METHODS
In this cross-sectional, multicentre study, a cohort of hospitals from the Solutions for Patient Safety network with varying race and ethnicity data collection systems submitted validated central line-associated bloodstream infection (CLABSI) and unplanned extubation (UE) data stratified by patient race and ethnicity categories. Data were submitted using a crosswalk created by the study team that reconciled varying approaches to race and ethnicity data collection by participating hospitals. Harm rates for race and ethnicity categories were compared with reference values reflective of the cohort and broader children's hospital population.
RESULTS
RESULTS
Racial and ethnic disparities were identified in both harm types. Multiracial Hispanic, Combined Hispanic and Native Hawaiian or other Pacific Islander patients had CLABSI rates of 2.6-3.6 SD above reference values. For Black or African American patients, UE rates were 3.2-4.4 SD higher. Rates of both events in White patients were significantly lower than reference values.
CONCLUSIONS
CONCLUSIONS
The combination of harm data across hospitals with varying race and ethnicity collection systems was accomplished through iterative development of a race and ethnicity category framework. We identified racial and ethnic disparities in CLABSI and UE that can be addressed in future improvement work by identifying and modifying care delivery factors that contribute to safety disparities.
Identifiants
pubmed: 37460119
pii: bmjqs-2022-015786
doi: 10.1136/bmjqs-2022-015786
pii:
doi:
Types de publication
Journal Article
Langues
eng
Investigateurs
Emily Huffman
(E)
Dionne A Graham
(DA)
Sara Green
(S)
Steven Viramontes
(S)
Margaret Richmond
(M)
Glenn Bushee
(G)
Kelly N Kennedy
(KN)
Audrey H Barnett
(AH)
Mary Saccoccio
(M)
Anu Partap
(A)
Carolina Typaldos
(C)
Rebecca Kerns
(R)
Kevin A Slavin
(KA)
Corinne Corrigan
(C)
Robert J Gajarski
(RJ)
Caitlin McGrath
(C)
Angela Niesen
(A)
Kathryne H Basta
(KH)
Jan Schriefer
(J)
Loreta Matheo
(L)
Laura Konkol
(L)
Raed M Khoury
(RM)
Jeremy Santoro
(J)
John Andrew Young
(JA)
Christine LeRoy
(C)
Laurel B Moyer
(LB)
Charles G Macias
(CG)
Tariq Chaudry
(T)
Informations de copyright
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.