Identifying and Addressing Healthcare Disparities in the Pediatric Acute Care Setting Restricted; Files Only

Abstract

Healthcare disparities refer to differences between groups in access to and use of healthcare, health insurance coverage, and quality of care that cannot be explained by differences in health needs, patient preferences, or treatment regimens. In the pediatric acute care setting, healthcare disparities have been linked to social and structural determinants of health such as economic stability, neighborhood and built environment, and healthcare access. Addressing healthcare disparities related to social and structural determinants of health is complex due to barriers such as multifactorial root causes, challenges with identifying disparities in a systematic and standardized manner and implementing effective interventions. Manuscript I was a qualitative study that describes processes that children’s hospital leadership are taking to identify and address healthcare disparities, as well as perceived facilitators and barriers within their institution. Manuscript II was a quantitative study that evaluates whether the Childhood Opportunity Index is associated with patient-level morbidity and mortality following surgery for congenital heart defects in Atlanta, Georgia. Lower-level childhood opportunity levels were associated with a greater risk of poor outcomes and longer postoperative hospital length of stay. Manuscript III was a post-hoc analysis of a clinical decision support (CDS) intervention to determine the impact of CDS on differences in influenza uptake by demographic factors and other social determinants of health. There were significant differences in influenza vaccination rates between sex and racial groups that resolved post-CDS implementation, highlighting the ability of CDS to address differences in adoption of evidence-based practices.

Table of Contents

Chapter 1: Research Protocol 

Introduction……………………………………………………………….….……….2 

Conceptual Framework……………………………………………….…….……….3 

Research Questions and Study Aims…………………………………………… 10 

Outline of the Dissertation…………………………………….......................11 

References……………………………………...………….………………….……..12 

Chapter 2: Hospital Leaderships’ Perceptions and Experiences in Identifying and Addressing Healthcare Disparities in Patient Care and Healthcare Outcomes at Free-Standing Acute Care Children’s Hospitals Nationally 

Abstract……………………………………...………….…………………………...15 

Background………….……………………...………….……………………………16 

Methods……………………………………...………….………………………......17 

Results…………….………………………...………….…………………………….20 

Discussion…………………………………...………….…………………….........42 

Limitations…………………………………...………….……………………..…...53 

Conclusion…………………………………...………….……………………..…...53 

References……………….…………………...………….…………………..…..….61 

Chapter 3: Examining the Association Between Child Opportunity Index and Pediatric Cardiac Surgical Outcomes Across One Georgia Metropolitan Area, 2010-2020 

Abstract……………………………………...………….……………………………65 

Background………….……………………...………….…………………..……….66 

Methods……………………………………...………….…………………………...68 

Results…………….………………………...………….…………………………….73 

Discussion…………………………………...………….………………..………....76 

Limitations…………………………………...………….……………..…………...79 

Conclusion…………………………………...………….…………………………...80 

References……………….…………………...………….………………………..….91 

Chapter 4: The Influence of Clinical Decision Support on Differences in Influenza  

Vaccine Uptake in Hospitalized Children  

Abstract……………………………………...………….……………….……………95 

Background………….……………………...………….…………………………….96 

Methods……………………………………...………….…………………………....98 

Results…………….………………………...………….……………….……………101 

Discussion…………………………………...………….…………………………...102 

Limitations…………………………………...………….…………………………..105 

Conclusion…………………………………...………….…………………………..106 

References……………….…………………...………….…………………………..109 

Chapter 5: Summary and Conclusions 

Summary of Results………………………………..…….…………………..…….115 

References……………….…………………...………….…………………………..119 

About this Dissertation

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School	Laney Graduate School
Department	Nursing
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Health Sciences, Nursing
关键词	Health Equity Pediatrics Acute Care
Committee Chair / Thesis Advisor	Lisa Thompson, Emory University
Committee Members	Melinda Higgins, Emory University Kathleen Adams, Emory University Susan Brasher, Emory University Swaminathan Kandaswamy, Emory University Evan Orenstein, Emory University

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