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Racial and ethnic inequities in health care quality have been described across a broad range of clinical settings, patient populations, and outcomes. Our overarching goal is to eradicate health care inequities through evidence-based interventions. The objectives of this proposal are to develop and test the impact of two interventions on overcoming clinician implicit bias and mitigating inequities in the management of pain among children seeking care in the emergency department for the treatment of appendicitis or long bone fractures.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Department-level audit and feedback and electronic health record-embedded clinical decision support | Experimental | Clinicians will receive monthly pooled, department-level 'Equity Report Cards' that will provide aggregate information on clinical data stratified by patient race/ethnicity. Subsequently, for all visits that may be related to appendicitis or long bone fracture, clinicians will then receive real-time, electronic health record-embedded clinical decision support regarding pain management. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Department-level audit and feedback and electronic health record-embedded clinical decision support | Behavioral | This intervention will provide clinicians with Equity Report Cards and clinician decision support on mitigating disparities in quality of care. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain reduction | Percentage of patients with pain reduction, pain is measured on a 0 to 10 scale, 0 is the minimum and 10 is the maximum, a lower score is a better outcome. | Equity Report Cards provided monthly to clinicians over a 24-month period |
| Analgesia use | Rate of analgesia use | Equity Report Cards provided monthly to clinicians over a 24-month period |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Monika Goyal, MD | Contact | 2024762869 | mgoyal@cnmc.org | |
| Meleah Boyle | Contact | 2024765388 | mdboyle@childrensnational.org |
| Name | Affiliation | Role |
|---|---|---|
| Monika Goyal | Children's National Research Institute | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Children's National Hospital | Recruiting | Washington D.C. | District of Columbia | 20016-1838 | United States |
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| ID | Term |
|---|---|
| D010146 | Pain |
| D001064 | Appendicitis |
| D063505 | Racism |
| D050723 | Fractures, Bone |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D059413 | Intraabdominal Infections |
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The study design is a pragmatic clinical trial.
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| D007239 | Infections |
| D005759 | Gastroenteritis |
| D005767 | Gastrointestinal Diseases |
| D004066 | Digestive System Diseases |
| D002429 | Cecal Diseases |
| D007410 | Intestinal Diseases |
| D011287 | Prejudice |
| D012919 | Social Behavior |
| D001519 | Behavior |
| D063508 | Social Discrimination |
| D014947 | Wounds and Injuries |