Division of Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington.
Division of Pediatric Emergency Medicine, Department of Pediatrics, Duke University School of Medicine, Duke University Health, Durham, North Carolina.
Pediatrics. 2024 Sep 1;154(3). doi: 10.1542/peds.2024-065922.
Interventions aimed to standardize care may impact racial and ethnic disparities. We evaluated the association of race and ethnicity with adherence to recommendations from the American Academy of Pediatrics' clinical practice guideline for febrile infants after a quality improvement (QI) intervention.
We conducted a cross-sectional study of infants aged 8 to 60 days enrolled in a QI collaborative of 99 hospitals. Data were collected across 2 periods: baseline (November 2020-October 2021) and intervention (November 2021-October 2022). We assessed guideline-concordance through adherence to project measures by infant race and ethnicity using proportion differences compared with the overall proportion.
Our study included 16 961 infants. At baseline, there were no differences in primary measures. During the intervention period, a higher proportion of non-Hispanic white infants had appropriate inflammatory markers obtained (2% difference in proportions [95% confidence interval (CI) 0.7 to 3.3]) and documentation of follow-up from the emergency department (2.5%, 95% CI 0.3 to 4.8). A lower proportion of non-Hispanic Black infants (-12.5%, 95% CI -23.1 to -1.9) and Hispanic/Latino infants (-6.9%, 95% CI -13.8 to -0.03) had documented shared decision-making for obtaining cerebrospinal fluid. A lower proportion of Hispanic/Latino infants had appropriate inflammatory markers obtained (-2.3%, 95% CI -4.0 to -0.6) and appropriate follow-up from the emergency department (-3.6%, 95% CI -6.4 to -0.8).
After an intervention designed to standardize care, disparities in quality metrics emerged. Future guideline implementation should integrate best practices for equity-focused QI to ensure equitable delivery of evidence-based care.
旨在规范医疗的干预措施可能会影响种族和民族差异。我们评估了种族和民族与美国儿科学会（AAP）发热婴儿临床实践指南建议的一致性，该评估基于一项质量改进（QI）干预。
我们对参加了 99 家医院 QI 合作的 8 至 60 天龄婴儿进行了一项横断面研究。数据在两个时期收集：基线（2020 年 11 月至 2021 年 10 月）和干预期（2021 年 11 月至 2022 年 10 月）。我们通过婴儿的种族和民族比较项目措施的符合率，来评估指南的一致性，使用比例差异来表示。
我们的研究纳入了 16961 名婴儿。在基线时，主要措施没有差异。在干预期间，有更多的非西班牙裔白人婴儿获得了适当的炎症标志物（比例差异 2%[95%置信区间（CI）0.7 至 3.3]）和记录了从急诊科的随访情况（2.5%，95%CI 0.3 至 4.8%）。非西班牙裔黑人婴儿（-12.5%，95%CI -23.1 至 -1.9%）和西班牙裔/拉丁裔婴儿（-6.9%，95%CI -13.8 至 -0.03%）的记录表明，他们获得了关于获取脑脊液的共同决策。获得适当的炎症标志物的西班牙裔/拉丁裔婴儿的比例较低（-2.3%，95%CI -4.0 至 -0.6），从急诊科获得适当的随访比例较低（-3.6%，95%CI -6.4 至 -0.8）。
在一项旨在规范护理的干预措施之后，质量指标的差异出现了。未来实施指南时，应纳入以公平为重点的 QI 的最佳实践，以确保提供公平的循证护理。
