Disparities in health outcomes have been well documented and have received considerable attention in recent years. There is increasing evidence that structural racism, and its effects on social drivers of health (SDH), including health care access and quality, education, food accessibility, neighborhood, and the environment may lead to adverse health outcomes. The goal of the ADAPT Research Lab is to identify and understand the causes of these disparities which will then inform the development of interventions that can improve healthcare for all.
PAINED: Project Addressing Inequities in the Emergency Department
With support from the National Institutes of Health (NIMHD R03 MD011654), our team previously demonstrated:
Children often receive different treatment based on their race and ethnicity with respect to pain management for conditions such as appendicitis and long bone fractures.
With funding from the NIH (NIDDK R61/R33 DK135406), our team will build on this prior work using a stakeholder-engaged approach to identify patient-centered quality metrics and examine the association between implicit bias and clinical outcomes. We will then develop and implement audit feedback and clinical decision support (CDS) to reduce inequities in pain management among pediatric patients.
Building an Anti-Racist Health System: A Quality Improvement Project
Families in Washington, D.C. and nationwide face overwhelming, avoidable impacts of racism within the healthcare system.
Previous research has shown racial disparities for asthma and mental health conditions.
Mental Health:Black Americans also disproportionately face risk factors linked to mental health conditions, including poverty, homelessness, violence, and lack of insurance coverage. According to the CDC’s Youth Risk Behavior Survey, 16% of D.C. high school students attempted suicide in the past year, with Black and Hispanic student rates at 16% and 15% respectively vs. 5% for among White students.
With funding from the Jessie Ball DuPont Foundation, our team will use a quality improvement framework to address inequities in the management of asthma and mental health-related concerns for children seeking care in the emergency department so we can move towards providing fair, equitable, and evidence-based care to all our patients.
BearSCREEN: Survey of Comprehensive Risk Evaluation and Emerging Needs
We previously demonstrated that patients and families are receptive to screening and intervention for social determinants of health in the ED. From 2017-2019, the BearSCREEN was used to survey more than 1,000 caregivers and adolescents in the ED to assess unmet social needs and provide support. Nearly 40% of caregivers and 52% of adolescents surveyed reported at least three unmet needs.
Sexually transmitted infections (STIs) disproportionately affect adolescents and Washington, D.C. has one of the highest rates of STIs nationally. Our team has previously highlighted a disparity in STI testing and barriers to prescription filling after being diagnosed with an STI.
To improve the sexual health of youth, our team developed computerized Sexual Health Survey (SHS), now called the Teen Health Screen (THS) to assess STI risk among adolescents. This screener is now being used to implement broad scale STI screening, detection, and treatment in the pediatric ED through funding from the NIH (NICHD R01 HD094213 and NIAID R01 AI163232). This work is instrumental in demonstrating that digital health can provide cost efficient, patient-centered care to improve health outcomes nationwide.
Funded by NIH and the Adolescent Trials Network, we currently have two grants that focus on implementing broad scale HIV screening, detection, and prevention through integration of computerized surveys in the ED workflow and use of digital health to improve HIV PrEP initiation.
Firearm Injury Prevention
Safer through Advocacy, Firearm Education and Research (SAFER) is a Firearm Injury Prevention Working Group at Children’s National Hospital. SAFER started as a conversation between several pediatric emergency medicine physicians who were discussing ways to reduce firearm injuries among youth. Since SAFER was established in 2016, we have grown to multi-disciplinary team of over 40 clinicians and researchers with representation from Adolescent Health, Epidemiology and Biostatistics, Child Health Advocacy Institute, Emergency Medicine, Hospitalist Medicine, Primary Care, and Psychiatry. We also collaborate with numerous colleagues nationwide. We are dedicated to reducing firearm-related injuries and deaths in children through the application of strong research methods, education, and advocacy. We have published more than 20 manuscripts, presented our work at national and regional conferences, and have coordinated outreach events with non-profit community groups.
In previous work, we found that children in states with strict gun laws are less likely to die than children in states with less strict gun laws.
