Overcoming Healthcare Disparity

PHILADELPHIA—Quality improvement (QI) tools in pediatric rheumatology can help overcome health outcome disparities that are based on race, gender identity, income and other factors, experts said in a session at ACR Convergence.

Dr. Smitherman

With it well established that these disparities exist, it’s time to begin eliminating them, said Emily Smitherman, MD, MS, assistant professor of pediatric rheumatology at the University of Alabama at Birmingham.

Real-World Solutions

“We need to start working toward solutions in the real world,” said Dr. Smitherman. “Equity should really be at the forefront of all quality improvement work.”

A starting point is to think about the measures being used to identify and monitor disparities, she said, adding that standards should be established for capturing key variables on assessing health equity. Measures specifically geared toward health equity, such as screenings by race and ethnicity and screenings for social risk factors, should be woven into care management.

When integrating health equity into QI projects, Dr. Smitherman suggested a framework that includes reviewing baseline data on existing disparities, building a project team that includes patients, setting goals for equity, assessing how social factors contribute to outcomes and then crafting improvements.

She emphasized the use of digital information. “How can we use digital information to plan both individual patient care, but also think about our population and how we’re delivering care?” she asked.

Her center is involved with the Pediatric Rheumatology Care and Outcomes Improvement Network, a multi-center effort with the goal of collecting “data from every visit for every patient at every center, which requires a large data infrastructure.”

“There is a plan to stratify all measures by race, ethnicity [and] sex so both centers can really examine what is happening for our patients across the network,” she said.

Mental Health Parity

Dr. Gilbert

Mileka Gilbert, MD, PhD, associate professor of pediatrics at the Medical University of South Carolina, underscored the importance of using QI processes to address disparities in mental health among children with rheumatic diseases.

Estimated rates of depression among pediatric systemic lupus erythematosus (SLE) patients, for example, are 20% to 59%, with suicidal ideation at 14% and anxiety at 17% to 37%. Juvenile idiopathic arthritis also brings a high rate of mental health concerns, Dr. Gilbert said, and depression and anxiety are associated with a worse quality of life, disability, stress and pain.²