Research Priorities for Pediatric Emergency Care to Address Disparities by Race, Ethnicity, and Language

This survey study investigates research priorities among medical personnel, researchers, and community organizations to address disparities in pediatric emergency care.

26. Inequities in provision of care in the ED including visit length, provider interaction time, and discharge and follow-up communication by preferred language/race/ethnicity 27.Understanding how race/ethnicity impacts grieving, receipt of bad news, access to social work or other resources Please use this space to include any comments you have on the priorities above.Please indicate the priority number(s) if referring to a specific priority or priorities.
Please use this section to submit additional priorities for consideration that your group would like us to consider but did not see above.

Family/Community Partner Survey 1: Disparities in Pediatric Emergency Care Research Agenda
A group of pediatric emergency medicine researchers are working to create a list of possible future research priorities (a "research agenda") for healthcare inequities and outcome disparities in pediatric emergency care (see definitions below).We would like your assistance ranking these priorities.Healthcare inequities: Health inequities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age.Health inequities are unfair and could be reduced by the right mix of government policies.(www.who.int)Outcome Disparities: Health disparities are preventable differences in the burden of disease, injury, violence, or in opportunities to achieve optimal health experienced by socially disadvantaged racial, ethnic, and other population groups, and communities Figuring out the best way to collect information about patients' race, ethnicity, and language 3. Improving options to describe patient identity based on their gender, race, ethnicity, etc. (For example, giving more options for patients who typically select "other" for their racial identity.)4. Improving the way we determine preferred language for patients in research studies, and which patients have a limited understanding of English and/or need interpreters 5. Recognizing and reducing implicit (subconscious or unconscious) bias in Pediatric Emergency Medicine providers 6. Making sure patients in the emergency department are seen based on how sick they are regardless of their race, ethnicity, or preferred language 7. Figuring out ways to increase the use of interpreters for those who need interpreters 8. Understanding obstacles to using interpreters

rank each of the proposed items below with a score between 1 (highest priority) and 5 (lowest priority) based on your group's input. NOTE -Background information for items #10-17 below: There is research that shows there are disparities and inequities in the following areas. For each area, what is the priority for future research to find the source of these problems and to improve them.
. (www.cdc.gov)Please complete the survey below indicating the responses for your group (one response per group, please).If you feel there is an item that you either do not have enough information to score or do not feel that your group has an opinion about, you can leave it blank.Thank you!Please 1. Investigate how to best use shared decision making* in research studies to reduce disparities.[*Shared decision making is a process in which clinicians and patients work together to make decisions and select tests, treatments and care plans based on clinical evidence and patient preferences and values (healthit.gov)]2.

Partner Survey 2: Disparities in Pediatric Emergency Care Research Agenda We
Differences in sickness and death that occur before a patient reaches the emergency department based on factors like their age, geography (rural vs. urban), race/ethnicity, and preferred language 24.Impact of governmental policies on reducing disparities 25.Impact of standardizing medical care (like following guidelines) on inequity and disparities 26.Differences in how care is provided in the ED (including visit length, time with a provider, and Please note, survey instruments were sent via email with an introductory message and delivered using REDCap.The survey instrument had radio buttons for participants to select their scores for each priority.The text of the body of the survey instrument is included below.are working to prioritize a research agenda for healthcare inequities and outcome disparities in pediatric emergency care based on race, ethnicity, and preferred language.We are considering research priorities in the domains of: Identifying Disparities, Understanding Sources of Disparities, Developing and Testing Interventions Aimed at Improving Disparities, Research Process and Methods, and Workforce Diversity.Please complete the survey below by January 21, 2022.NOTE: You may save and return to the survey if needed. discharge and follow-up instructions) based on patient preferred language/race/ethnicity 27.Understanding how race/ethnicity impacts grieving and receiving bad news, and access to social workers or other resources (like a chaplain)Please use this space to include any comments you have on the priorities above.Please indicate the priority number(s) if referring to a specific priority or priorities.Please use this section to submit additional priorities for consideration that your group would like us to consider but did not see above.eAppendix 2: Survey 2

Please assign each of the proposed items below a score between 1 (highest priority) and 5 (lowest priority) based on your group's input (if submitting a group response) or based on your priorities (if submitting an individual response). All the following research priorities apply to the pediatric emergency care setting unless otherwise specified. For the purposes of this project, our focus is on inequities and disparities related to race
Recognizing and Mitigating Implicit Bias in PEM Providers: Identify contributing factors to implicit bias in PEM providers; Implement bias-reduction strategies, and measure the impact of these strategies 3. Triage/Acuity Score Assignment: investigate inequities in the triage process that may contribute to disparities in scores by REaL; develop, implement, and assess interventions to reduce inequities/disparities in triage 4. Mental Health: Investigate inequities in pediatric emergency mental health service access, medication administration, and de-escalation methods; investigate disparities in mental health disposition and treatment; develop, implement, and assess interventions to reduce disparities in pediatric emergency mental healthcare; Investigate how REaL impacts grieving, receipt of bad news, access to social work or other resources 5. Systematic Efforts to Reduce Inequities: Assess impact of care standardization (evidence-based guidelines, pathways, order sets and other electronic-medical-record-based tools) on inequity and disparities in the pediatric emergency setting; investigate variations in approach to common sentinel presentations (febrile infants, sedation, fracture management, suspected abuse, etc.) and use of standardized tools based on patient race, ethnicity, and preferred language 6. Disparities in Acute Pain Management: Investigate sources of disparities in pain management; develop, implement, and assess interventions to reduce inequities/disparities in pain management 7. Emergency Department Quality of Care Metrics: Evaluate inequities in care provision in the ED including provider wait time, provider interaction time, and discharge and follow-up communication; Evaluate disparities in ED visit outcomes including visit length and return visits; Assess understanding of and compliance with discharge instructions 8. Pre-hospital and Inter-hospital Practices: Evaluate inequity in EMS practices (such as type of dispatch response, decision to transport, restraint use, and protocol adherence); Evaluate disparities in pre-hospital law enforcement involvement; Evaluate the impact of REaL on interfacility transfers to specialty hospitals 9. Shared Decision Making: Investigate how to best use shared patient decision making in pediatric emergency care and research to reduce disparities; Develop a tool to measure meaningful engagement of patients and families in pediatric emergency care; Assess the impact of health literacy, language, and culture on decision-making of parents/guardians regarding plans of care for their children 10.Restraint and Security Practices: Evaluate inequity in medical and physical restraint use; Evaluate disparities in use of hospital security and law-enforcement presence for pediatric emergency patients 11.Clinical and Research Team Characteristics: Evaluate how the clinical team's (nurses, advanced practice providers, physicians, etc.) race/ethnicity/language impacts patient care for minoritized populations; Evaluate how research team race/ethnicity/languages spoken impacts minoritized patients' willingness to participate in research; Investigate how leadership diversity, policies, and programs impact diversity of clinical and research teams 12. Language and Literacy in Pediatric Emergency Care: Investigate discrepancies between preferred language and health literacy; Implement and test interventions to increase interpreter use; Evaluate inequity in consent and discharge instruction availability in non-English languages 13.Research Participation: Investigate how patient race/ethnicity/preferred language impacts willingness to participate in research; Implement and assess strategies to build trust and show trustworthiness among marginalized populations 14.Policy Impact: Investigate the impact of governmental (federal, state, and local) policies on reducing health disparities; Investigate the impact of institutional policies on reducing health disparities 15.Patient Experience: Investigate disparities in patient and family experience in pediatric emergency care; Implement and assess efforts to include diverse patient and family input in clinical and research advisory boards 16.Social Determinants of Health (SDoH): Investigate the interplay between REaL and additional social determinants of health (age, disability, sexual orientation and gender identity, insurance, housing, geographic location, adverse childhood experiences, etc.); Investigate the impact of interventions such as use of healthcare navigators and screening and providing resources for SDoH on disparities Please use this space to include any comments you have on the priorities above.Please indicate the priority number(s) if referring to a specific priority or priorities.
, ethnicity, and language preference (referred to below as "REaL").1.Race, Ethnicity and Language (REaL) Data Collection and Reporting: Evaluate and develop best practices for accurately capturing race, ethnicity, and language (REaL) data; Improve options for patients who identify with racial or ethnic groups not typically represented in current data collection schemes; Evaluate current REaL data reporting practices and consolidate guidance for pediatric-specific REaL data use and reporting 2.

Partner Survey 2: Disparities in Pediatric Emergency Care Research Agenda As
you may recall from survey 1, a group of pediatric emergency medicine researchers are working to create a list of possible future research priorities (a "research agenda") for healthcare inequities and outcome disparities in pediatric emergency care (see definitions below) based on race, ethnicity, and preferred language.We would like your assistance ranking these priorities.Healthcare inequities: Health inequities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age.Health inequities are unfair and could be reduced by the right mix of government policies.(www.who.int)Outcome Disparities: Health disparities are preventable differences in the burden of disease, injury, violence, or in opportunities to achieve optimal health experienced by socially disadvantaged racial, ethnic, and other population groups, and communities.(www.cdc.gov)The following survey contains items that scored highly on survey 1, with some edits and additions suggested by participants.Please complete the survey below based on your group's input (if submitting a group response) or based on your priorities (if submitting an individual response) by January 21, 2022.NOTE: You may save and return to the survey if needed.Thank you!

Please assign each of the proposed items below a score between 1 (highest priority) and 5 (lowest priority) based on your group's input (if submitting a group response) or based on your priorities (if submitting an individual response). All the following research priorities apply to the pediatric emergency care setting unless otherwise specified. For the purposes of this project, our focus is on inequities and disparities related to race, ethnicity, and language preference (referred to below as "REaL").
Acuity Score Assignment: Make sure patients in the pediatric emergency department are seen based on how sick they are regardless of their race, ethnicity, or preferred language 4. Mental Health: Study disparities in pediatric emergency mental health care; design programs to reduce disparities in pediatric emergency mental healthcare; Study differences in grieving and receipt of bad news, and differences in access to social work and other resources 5. Systematic Efforts to Reduce Inequities: Study whether guidelines and national standards reduce disparities in the pediatric emergency setting; Investigate differences in approaches to similar conditions for patients with different races, ethnicities, preferred languages 6. Disparities in Acute Pain Management: Study disparities in pain management; design programs to reduce disparities in pain management 7. Emergency Department Quality of Care Metrics: Study differences in how care is provided in the ED (including wait times, time with a provider, and discharge and follow-up instructions) and outcomes like visit length and return visits; Study patient understanding and ability to follow discharge instructions 8. Pre-hospital and Inter-hospital Practices: Evaluate differences in how first responders (like paramedics) manage patients; Evaluate differences in police interactions with patients before they arrive to the ED by REaL; Study disparities in transfers to specialty hospitals 9. Shared Decision Making: Study how PEM providers can work with patients and families when making decisions (also called shared decision making) and how this can affect disparities.Study how language, culture, and ability to understand health information impact how patients and families make decisions.Design a program to help patients and families understand different health decisions 10.Restraint and Security Practices: Study differences in restraint use (both physical restraints and sedating medicines) for patients who may harm themselves or others; Study differences in in use of hospital security and police presence for pediatric emergency patients 11.Clinical and Research Team Characteristics: Study how the clinical team's race/ethnicity/language impacts care for patients from minority groups; Study how research team race/ethnicity/languages spoken impacts patient and family willingness to participate in research; Study how leadership diversity, policies, and programs impact diversity of medical and research teams 12. Language and Literacy in Pediatric Emergency Care: Study differences between a patient's preferred language and their ability to understand health information and make health decisions; Try to increase interpreter use for those who need them; Study differences in consent form and discharge instruction availability in non-English languages 13.Research Participation: Study how patient race/ethnicity/preferred language affects the decision to participate in research; Design programs to build trust and show trustworthiness among populations that have been excluded from research or are hesitant to participate 14.Policy Impact: Study the impact of governmental (federal, state, and local) policies on reducing health; Study the impact of institutional policies on reducing health disparities 15.Patient Experience: Study disparities in patient and family experience in pediatric emergency care; Assess efforts to include diverse patient and family input in clinical and research advisory boards 16.Social Determinants of Health (SDoH): Study the interaction between REaL and additional SDoH; Study programs that provide resources for SDoH; [Social determinants of health (SDoH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.(https://health.gov/healthypeople/objectives-and-data/social-determinants-health)] Please use this space to include any comments you have on the priorities above.Please indicate the priority number(s) if referring to a specific priority or priorities.