PEACH Projects

Research Design Stage

Risk Communication in Urology (Learning Health Sciences)

Project Lead: FW Williamson

Question: Are there inequities in the occurrence and quality of risk communication with pediatric urology patients and caregivers?

Follow-up care for intraventricular shunts (Neurosurgery)

Project Leads: Kennedy Miller and Karin Muraszko

Question(s): Follow-up care for very low birthweight infants with Grade III/IV intraventricular hemorrhage who receive an intraventricular shunt (IVS) is essential to ensure proper functioning of the shunt and to prevent an adverse neurological condition known as hydrocephalus. Are there differences among groups of infants (race, gender, SES, language) with IVS regarding routine follow up after shunt placement? Are there differences among groups of infants (race, gender, SES, language) with IVS regarding imaging after shunt placement? Which children are referred to social work prior to discharge from shunt placement?

Restraints in Emergency Services (Emergency Medicine)

Project Leads: Breeanna Lorenzen and Prashant Mahajan

Question(s): Does use of restraints vary for pediatric patients by race, socioeconomic status, weight status, primary language spoken, and gender in Pediatric Emergency Services, Pediatric Psychiatric Emergency Services, and Adult Emergency Services?

Management of psychiatric patients in Emergency Services (Emergency Medicine)

Project Leads: Breeanna Lorenzen and Prashant Mahajan

Question(s): Amongst patients with specific psychiatric diagnoses, are there differences in evaluation and management of patients by race, ethnicity, socioeconomic status, gender and weight?

Central Line Bloodstream Infection (Mott - Quality)

Project Lead: Jamie MacLaren

Question(s): Are there inequities by race, ethnicity, and language in CLABSI prevention practices?

C-Sections (Mott - Quality)

Project Lead: Carolina Typaldos 

Question(s): C-section rates for first-time, low-risk mothers are below the expected rate for White mothers, while above the expected rate for Black mothers and this gap seems to be widening. What is the reason for this gap? 

Data Retrieval and Collection Stage 

Rooming in ("block of care") in cardiology (Mott-Nursing)

Project Lead: Karen Wilson

Question(s): Do caregivers of pediatric patients (one and under) in cardiology receive the same rooming in requirements across racial and socioeconomic backgrounds? 

CPS referrals (Pediatric Surgery)

Project Lead: Keyonna Williams

Question(s): Are there differences in referral to Child Protective Services for specific injuries by race, ethnicity, income gradient and gender?

Threshold for bilateral ear tubes (Otolaryngology)

Project Lead: Terrence Pleasant

Question(s): Does the practice of ear-tube insertion vary by race or socioeconomic status?

Weight Loss Management (Pediatrics)

Project Lead: Susan Woolford

Question(s): Are weight loss medications prescribed differentially for those 13-21 years old by race, ethnicity, socioeconomic status, and gender? Is there a clinic or location effect? Is there an insurance effect?


Pain management & scoliosis (Anesthesiolgy)

Project Lead: Rebecca Hong 

Question(s): Is there a difference in pain management between neuromuscular and idiopathic pediatric patients? Within the neuromuscular group, is there a difference if the patient is verbal versus nonverbal?

Spinal v. general anesthesia during infant circumcision (Anesthesiology)

Project Lead: Anne Baetzel 

Question(s): Are there racial and socioeconomic differences among infants undergoing delayed circumcision (4-35 months) in terms of whether they receive awake spinal anesthesia or general anesthesia? 

 Acute osteomyelitis management (Pediatric Infectious Diseases)

Project Leads: Jason Weinberg, Liz Lloyd and Tim Schurz

Question(s): Did implementation of institutional guidelines for management of acute osteomyelitis improve patient outcomes and decrease variablity in treament based on race, ethnicity, primary language, SES and gender? Are there inequities currently present?

Rapid response outcomes (Pediatric Critical Care)

Project Leads: Dario Alvarez and Erin Carlton

Question(s): Does activation of the Rapid Response Team (RTT) vary by preferred language, SES (median income, ADI, and type of insurance), race, ethnicity, gender, and BMI? Amongst those with an RTT activated, is there a differentiation of timing of when the RRT is called for children admitted for a specific diagnosis (i.e., bronchiolitis)? Amongst those with an RRT called, does intubation within six hours of RRT vary by social factors? Amongst those with an RRT called, does use of vasoactive medications within six hours of RRT vary by social factors?

Variation in care around inflammatory bowel disease (Gastroenterology)

Project Lead: Jeremy Adler and Keyonna Williams

Question(s): For patients with IBD, does the time from first gastroenterology appointments to evaluation (endoscopy) and imaging (MRI) procedures vary by race, ethnicity, socioeconomic status and gender?


Data Analysis Stage

Responses to housing and food insecurity in primary care  (Poverty Solutions)

Project Lead: Jennifer Erb-Downward  

Question(s): Do children and adolescents whose caregivers report a concern about housing or food insecurity receive appropriate referrals to services within the primary care setting?

Variation in trauma care (Pediatric Surgery)

Project Leads: Keyonna Williams and Peter Ehrlich

Question(s): Are there differences in care provided to pediatric trauma patients relative to English proficiency, SES, and other social factors?


Human Papillomavirus (HPV) vaccination among pediatric patients with and without disabilities  (Obstetrics & Gynecology)

Project Lead: Monica Rosen

Question(s): Does disability status, race, and ethnicity impact likelihood of whether female patients seen in Michigan Medicine primary care clinics receive any vaccination for human papillomavirus (HPV)?

Equity Assessment Stage

Bereaving family interventions or "Legacy Interventions" (Mott-Child Life)

Project Leads: Maleea Roy and Meredith Irvine

Question(s): Legacy Interventions are offered at the hospital to provide support to families of patients who pass away. They involve keepsakes in memoriam of the deceased, including molds and prints of hands and feet, locks of hair, heartbeat recordings, and pendants. Are Legacy Interventions provided universally to all bereaving families of pediatric patients?

Restraints & seclusion in the psychiatric unit (Psychiatry)

Project Lead: Katie Kruse 

Question(s): Does use of restraints and seclusion vary for pediatric patients by race, socioeconomic status, weight status, primary language spoken, and gender in: 


Sexually transmitted infection testing among pediatric patients with and without disabilities  (Obstetrics & Gynecology)

Project Lead: Monica Rosen

Question(s): Do providers conduct sexually transmitted infection (STI) testing equally among female adolescents with and without disabilities?

Quality Improvement Stage

Vision screenings across clinics (Ophthalmology)

Project Lead: Gary Freed 

Question(s): Are there differences in the rates of vision screenings across clinics for pediatric patients (3-5)? Do these differences contribute to racial and socioeconomic inequities in vision screenings?

Kangaroo or skin-to-skin care (Mott-NICU)

Project Lead: Rachael Pace

Kangaroo care (a method of holding a baby to a caretaker's chest for skin-to-skin contact) is vital to ensuring optimal immediate and long-term cognitive, social, and behavioral outcomes for children born preterm or with low birth weight.


Rachael Pace, a senior clinical information analyst in the Neonatology Division at Mott, posed the question: For very low birthweight patients in the first 14 days of life spent in the NICU, is the duration of Kangaroo Care the same across patients of different racial and socioeconomic backgrounds?


Analyses found that of 239 inborn very low birthweight patients in the NICU, White infants had higher durations of Kangaroo Care compared to Black patients. Area Deprivation Index (an indicator of socioeconomic status) in part explained these differences. Given a goal to ensure all caretakers of this population are appropriately encouraged and supported to conduct Kangaroo Care, this project is now in the improvement phase.


"This holistic care is the catalyst of so many great benefits and exemplifies our mission of prioritizing infants and families," said Pace.




Completion and Dissemination Stage

Drug testing in Emergency Services (Pediatrics)

Project Leads: Kimberly Slonaker, Anna McEvoy and Allison Cator

Question(s): Are there inequities in drug testing practices in Emergency Services for pediatric patients?

Meconium drug screening (Pediatrics-Hospitalist)

Project Lead: Maria Skoczylas, Amanda Costa and Lauren Oshman

Question(s):  Research has found that meconium drug screening on newborns varied by race at Michigan Medicine. Guidelines were implemented to standardize meconium drug screening  in 2023. Have the guidelines reduced variation by race?

Diagnostic laparoscopy for dysmenorrhea  (Obstetrics & Gynecology)

Project Leads: Katie O'Brien and Monica Rosen

Question(s): Is there inequity in what adolescents are offered and who receives a diagnostic laparoscopy for dysmenorrhea based on race, ethnicity, socioeconomic status, and language preference? 

Paused

Variation in care around growth faltering or failure to thrive (Pediatrics-Hospitalist)

Project Leads: Katherine Salada and Jodi Ehrmann

Question(s): Do children admitted to the general pediatric hospitalist service for growth faltering (previously known as "failure to thrive") vary by race/ethnicity, socioeconomic status, and primary language spoken in terms of: the threshold for admission, length of stay, social consultations received (e.g., social work and Children's Protective Services), and the threshold for discharge?

Same-day discharge for uncomplicated appendicitis (Pediatric Surgery)

Project Lead: Elizabeth Speck and Nikhil Shah

Question(s): Are there differences in length of stay after laparoscopic appendectomy for uncomplicated appendicitis by race, ethnicity, language preference, income gradient and gender? If so, are these differences caused by the health system? Can a standardized protocol designed by the research team help increase equity in same-day discharge procedures?

Referrals for fertility preservation consultation (Obstetrics & Gynecology)

Project Leads: Erin Isaacson and Monica Rosen 

Question(s): Are there inequities in who is referred for fertility preservation consultation among patients who receive medication that causes ovarian toxicity? 

Screening for iron deficiency with and without anemia (Pediatrics- Hematology Oncology)

Project Lead: Angela Weyand

Question(s): Are adolescents equitably screened for iron deficiency with and without anemia? 

Portal utilization and asthma care outcomes (Pediatrics-Pulmonology)

Project Lead: Toby Lewis

Question(s): Do patients who do not use the patient portal receive the same recommended protocols around asthma care as patients who do use the patient portal? Do patients without portal access have fewer interactions with healthcare system and worse outcomes?

Pain management and pain outcomes in Emergency Department  (Pediatrics-CHEAR)

Project Lead: Melinda Rushing

Question(s): Are there any associations between pain-treatment inequities in the Mott Emergency Department and uncontrolled pain episodes during subsequent admissions?

Delay in referral for idiopathic scoliosis and clinic no-show rates (Orthopaedic Surgery)

Project Lead: Ying Li

Question(s): For pediatric patients with scoliosis, do social factors such as race, ethnicity, and class impact the magnitude of the curve at the time of presentation to orthopaedics? Do no-shows and repeat cancelations vary by these social factors? What role does the health care system play in these outcomes?

Neonatal brachial plexus palsy (Neurosurgery)

Project Lead: Whitney Muhlestein

Question(s): Is there a relationship between race and socioeconomic status and severity of neonatal brachial plexus palsy? Are there disparities in access to specialized care, including therapy and surgery?