P3.O284: Advancing Equity in Pediatrics: An AAP chapter-led QI initiative to Improve EDI based behaviors.

Purpose/Objectives: The COVID-19 pandemic starkly highlighted the vast healthcare inequities and disparities in communities of color and those with low socioeconomic status. Many of these disparities are deeply rooted in the complex U.S. history of racism. In response, the New York State American Academy of Pediatrics (AAP) Chapter 3 – Equity, Diversity, and Inclusion (EDI) committee partnered with the United Hospital Fund to deliver the Advancing Equity in Pediatrics (AEP) Training – an adaptation of the Seattle Children Hospital’s academic institution based Generate and Teach Health Equity Routinely (GATHERTM). Featuring guest speakers and facilitators who bring both clinical experience and expertise in applying health equity principles, this two-part training aims to support child and adolescent health providers throughout New York State in reducing health care disparities and helping advance a culture of equity. The overall programmatic purpose is to improve participant engagement in EDI, using quality improvement, self-reflection, and peer discussion to favorably impact health disparities and advance health equity in the delivery of pediatric care.

Design/Methods: To qualify for participation in the equity-focused quality improvement portion of AEP, participants were asked to attend 3-5 virtual presentations on microaggressions, implicit bias, and patient bias. Subsequently, pediatricians voluntarily joined an adaptation of GATHERTM , Seattle Children’s Center for Diversity and Health Equity’s quality improvement (QI) intervention, which required: completing weekly GATHERTM self-assessment tools comprised of seven questions of EDI behaviors; setting an intention with individual SMARTIE aims to improve health equity; and attending three monthly peer-driven reflection meetings. During the meetings, led by trained members of AAP District II, participants discussed their progress in achieving their intention/SMARTIE aim, summarized survey results, verbalized barriers to, and developed strategies for increasing EDI in daily work.

Results: Of the 187 lecture series participants, 43 (23%) from throughout NYS chose to continue the equity-focused QI project. All seven self-reported positive EDI behaviors improved over time, with significant improvement from baseline to 1-3 months post-program in 3 of 7 behaviors: “I considered how the concepts of privilege and oppression may play into my relationship with a patient/family“ (OR 11.36, p=0.005); “I modeled what I learned in EDI training with colleagues and/or trainees “ (OR 2.99, p=0.031), and “I thought about assumptions that I may be making about a patient/family” (OR 31.26, p=0.0002). No statistically detectable differences were noted in behavior change among early vs late career providers, sub-speciality selection, and gender.

Conclusion/Discussion: Regardless of practice type/location, pediatricians require collaboration to train, educate, build skills, and identify EDI challenges. After participating in AEP, participants were more likely to report implementing all the studied positive EDI behaviors. This quality improvement program can be an important tool to assist health providers mitigate biased behaviors contributing to health disparities.