Overcoming Healthcare Disparity

Black children with SLE are more likely to have mental health disorders, but are less likely to be diagnosed and treated, Dr. Gilbert said.¹

“Given the known disparate outcomes in black adolescents and young adults with lupus, it is imperative that we address mental health disparities in our clinics to address lupus outcomes,” Dr. Gilbert said.

Quality improvement to address this problem first involves bringing together stakeholder—physicians, nurses and social workers, mental health providers, administrative leaders, patients and families, according to Dr. Gilbert.

Her center uses the American Board of Pediatrics Readiness Assessment, which sets out goals and lists related health-equity concerns, such as establishing a list of mental health providers, while being mindful of things travel distance, insurance status and other factors, and creating a crisis plan while accounting for contingencies that could complicate that plan.

“We had a patient who we recommended go into the emergency department (ED) for severe depression and suicidal ideation,” Dr. Gilbert said. “But what do you do in the case of a single mom who may need to accompany her child to the ED, but also brought other children with her?”

Clinicians must always be mindful to overcome disparities. “At each step of the process, we have to intentionally ask ourselves, what is the concern for health equity?”

Outcomes Illuminate Disparity

Dr. Burnham

Jon Burnham, MD, MS, clinical director of pediatric rheumatology at the Children’s Hospital of Philadelphia, showed how measuring outcomes in critical patient groups can illuminate disparities.

He described living with juvenile idiopathic arthritis (JIA) as “trying to walk up an escalator that is going in the wrong direction,” constantly monitoring disease and trying treatments and being faced with symptoms and flares. Factors leading to health disparities, such as lack of access to care, missing work and depression, can make that escalator move even faster, he said.

In 2016, his center began a project to standardize clinical assessment and treatment using a treat-to-target approach. With any intervention, the hope is that the outcomes of everyone will improve, while the disparities diminish. The result of this approach, he said, was that, while there was overall improvement, the disparities remained essentially the same, suggesting that more needed to be done.

An analysis of data since 2020 showed an even more alarming picture: Almost all measures associated with JIA, including disease activity scores (cJADAS) and pain, spiked for non-Hispanic Black patients, but not non-Hispanic white patients. The difference seemed to be driven by patient perception, reflected in the patient global assessment of well-being and measures of physical function.