Children's Hospitals Today - Winter 2022 - 19

QUALITY / FEATURE
to increase the resources and attention
we direct to improving behavioral
health outcomes and ascribe to them
the same importance and economic
value we ascribe to physical health
outcomes, " Keren says.
4. Health care equity
Of the six quality domains, improvement
perhaps lags most significantly
in the equity of care. A review published
by the American Academy of
Pediatrics in 2007 of nearly 60 years
of studies on the issue concluded " ...
racial/ethnic disparities in children's
health and health care are extensive,
pervasive and persistent, and occur
across the spectrum of health and
health care. " The persistence of inequities
is due in part to the relative
lack of focus in addressing them. A
survey among members of CHA's
Quality and Safety Leaders Forum in
2019 found equity ranked last among
the six domains.
" Not surprising to
rise in the incidence of pediatric behavioral
health cases before COVID-19,
and the pandemic exacerbated the
situation. The stresses of the pandemic
and social isolation amid widespread
school closures hit kids hard-
Children's Hospital Association's
Pediatric Health Information System
reports in the first half of 2021, cases of
self-injury and suicide in children ages
5-17 occurred at a 45% higher rate than
during the same period in 2019.
The current crisis has exposed the
limitations of the already strained behavioral
health care system in capacity,
workforce and programming from
the community setting through acute
care for children and teens. " We need
anyone, sadly, the equity domain has
played second fiddle to the remaining
five domains for decades, " says Paul
Sharek, M.D., M.P.H., vice president,
chief quality and safety officer, associate
chief medical officer, Seattle
Children's. " To achieve quantum improvements
in child health outcomes,
a focus on equity must be prioritized. "
The first challenge may be to ensure
everyone is on the same page regarding
the extent to which disparities
exist. Marcy Doderer, 2021 chair of
CHA's Board of Trustees, says in her
conversations with colleagues around
the country, she sees a disconnect in
how equity in pediatric health care
is quantified. " We have variations
in how we're measuring equity, how
comfortable we are with measuring
it and-almost more importantly-
how comfortable we are speaking to
those metrics and the outcomes, " says
Doderer, FACHE, president and chief
executive officer, Arkansas Children's.
Beers adds the key to addressing
TAKING ACTION
Addressing
inequities
David Nichols, M.D., MBA,
president and chief executive
officer, The American Board of
Pediatrics, outlines six steps
every children's hospital and
health system should take:
 Set a public goal to eliminate
disparities.
 Analyze care processes,
intermediate outcomes,
survival and quality of life
by race and ethnicity.
 Share data openly.
Transparency is key to
illustrate the scope of
the problem and show
improvement over time.
 Ask tough questions about
disparities: Why? What can
we do about them?
 Co-design improvement
cycles. Engage a multidisciplinary
team in
solutions, including-most
importantly-patient families
and community members.
 Disseminate what works
and celebrate what has
been achieved.
inequities in care for your community
is to look inward at your institution's
systems and spark change from
within. Beers says. " It is an area where
we've fallen short, and we must work
to actively address. "
Megan McDonnell Busenbark is a
freelance writer in Omaha, Nebraska.
Send questions or comments to
magazine@childrenshospitals.org.
CHILDREN'S HOSPITALS TODAY Winter 2022
19
Children's Hospitals Today - Winter 2022

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