About PEACH
Putting the spotlight on equity in pediatric care
Equity in the delivery of pediatric care is often taken for granted. We in the health-care system want to provide the best possible care to all adolescents and children. Yet, we also know that we exist in a society impacted by inequality and that in turn can shape our perceptions and actions, regardless of our good intentions. Children who differ in terms of characteristics such as ability status, gender, sexual orientation, income gradient, language, weight status, race, or ethnicity may enter the hospital or doctor’s office and be responded to differently due to one – or multiple – of those characteristics. In other words, these children may experience a health inequity.
Considerable research demonstrates health inequities in the way adult patients are provided care across multiple domains (e.g., different assessment of chest pain by gender and variation in pain management by race/ethnicity). Moreover, in other fields, such as education and law enforcement, we know inequities exist in the experiences of adolescents and children. However, we know very little about inequities in pediatric care and, critically, about the interventions that should be in place to address the inequities that exist.
Approaching equity through systems-level thinking
It is important to note that we do not believe that differences in care occur because of any evil intent on the part of providers or staff. At PEACH, we recognize we all hold unconscious biases, and these biases are unlikely to disappear simply by taking a class. Our goal is to focus on systems rather than on individuals, and implement protocols and structural changes to achieve equitable care.
A similar approach is taken when addressing safety in clinical care. Rather than blaming individuals, health-care systems accept that we as humans are fallible, so transparent measurement is encouraged, and process improvement is the norm. For example, to reduce preventable infections by improving hand hygiene, in addition to education, protocols are used, e.g., hand-sanitizer dispensers are placed at each patient door to make it easy to do the best thing for patient care. Drawing on the successes of this approach, we apply these same key principles to improve pediatric health equity.
Improving equity at PEACH
PEACH is a first-of-its-kind program designed to research and address inequities in pediatric care. We draw from a broad range of methodological techniques to examine whether inequities exist and their extent, and, if identified, we apply quality improvement science to improve equity. To carry out our work, PEACH functions as a hub of resources available to those in partnering units who have a question about pediatric equity. Faculty and staff propose ideas that they will take the lead in researching and addressing; PEACH provides support to help faculty and staff explore ideas, translate feasible ideas into research, and implement quality improvement programs to address any inequities identified through research.
PEACH is composed of physicians, researchers, statisticians, quality improvement specialists, and other experts who together provide faculty and staff a core platform of expertise, consultation, and support, including:
Consultations on potential inequities that fall within the scope of PEACH
Research design and methodological mentorship
Help developing and testing new methods to study inequity
Assistance with patient, community, and stakeholder engagement
Various supports over the life course of a project (e.g., data collection and statistical analysis supports)
Quality improvement assistance in developing and implementing solutions
Support in disseminating findings to advance research and improve pediatric care
Aid in writing proposals for extramural funds for state and national studies to assess inequities and develop interventions to address them
Small & medium grants to support research and quality improvement projects
At PEACH, we want to ensure those who share our commitment to equity in pediatric care have the resources needed to ask questions, collect data, and generate meaningful change.
PEACH will host learning sessions with invited speakers, seminar series, workshops, and other collaborative activities to discuss current projects, develop and refine methodological approaches to equity research, share and expand knowledge about inequities, and create impactful solutions to improve equity.
Impact
While our work starts at Michigan Medicine, we hypothesize that pediatric equity issues are present in other health systems across the state and the country. Thus, findings from our projects will be disseminated to inform local, state, and national decision makers to provide actionable steps to identify and address inequities. Ultimately, our goal is to improve equity in pediatric care for all.
This is critical work. Variation in clinical decision making or patient/family experience has the potential to make a substantial impact on the health and wellbeing of children, adolescents, and their families. PEACH will help improve patient and family experiences, lead to more equitable care, foster greater patient trust in recommended therapies and the healthcare system, and improve employee morale for all associated with these efforts.
