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Racial and ethnic disparities in common inpatient safety outcomes in a children’s hospital cohort
  1. Anne Lyren1,2,
  2. Elizabeth Haines3,4,
  3. Meghan Fanta5,6,
  4. Michael Gutzeit7,
  5. Katherine Staubach6,
  6. Pavan Chundi6,
  7. Valerie Ward8,9,
  8. Lakshmi Srinivasan10,11,
  9. Megan Mackey12,
  10. Michelle Vonderhaar6,
  11. Patricia Sisson6,
  12. Ursula Sheffield-Bradshaw6,
  13. Bonnie Fryzlewicz13,
  14. Maitreya Coffey14,15,
  15. John D Cowden16,17
  16. PHARE Cohort Study Group
    1. 1 Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
    2. 2 UH Rainbow Babies & Children's, Cleveland, Ohio, USA
    3. 3 Pediatrics and Emergency Medicine, New York University Grossman School of Medicine, New York, New York, USA
    4. 4 Hassenfeld Children's Hospital at NYU Langone, New York, New York, USA
    5. 5 Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
    6. 6 James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
    7. 7 Children's Hospital of Wisconsin, Wauwatosa, Wisconsin, USA
    8. 8 Boston Children's Hospital, Boston, Massachusetts, USA
    9. 9 Radiology, Harvard Medical School, Boston, Massachusetts, USA
    10. 10 Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
    11. 11 University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
    12. 12 Special Education and Interventions, Central Connecticut State University, New Britain, Connecticut, USA
    13. 13 Seattle Children's Hospital, Seattle, Washington, USA
    14. 14 The Hospital for Sick Children, Toronto, Ontario, Canada
    15. 15 Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
    16. 16 Department of Pediatrics, Children's Mercy Hospital Kansas, Overland Park, Kansas, USA
    17. 17 University of Missouri–Kansas City School of Medicine, Kansas, Missouri, USA
    1. Correspondence to Dr Anne Lyren, Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; Anne.Lyren{at}


    Background Emerging evidence has shown racial and ethnic disparities in rates of harm for hospitalised children. Previous work has also demonstrated how highly heterogeneous approaches to collection of race and ethnicity data pose challenges to population-level analyses. This work aims to both create an approach to aggregating safety data from multiple hospitals by race and ethnicity and apply the approach to the examination of potential disparities in high-frequency harm conditions.

    Methods In this cross-sectional, multicentre study, a cohort of hospitals from the Solutions for Patient Safety network with varying race and ethnicity data collection systems submitted validated central line-associated bloodstream infection (CLABSI) and unplanned extubation (UE) data stratified by patient race and ethnicity categories. Data were submitted using a crosswalk created by the study team that reconciled varying approaches to race and ethnicity data collection by participating hospitals. Harm rates for race and ethnicity categories were compared with reference values reflective of the cohort and broader children’s hospital population.

    Results Racial and ethnic disparities were identified in both harm types. Multiracial Hispanic, Combined Hispanic and Native Hawaiian or other Pacific Islander patients had CLABSI rates of 2.6–3.6 SD above reference values. For Black or African American patients, UE rates were 3.2–4.4 SD higher. Rates of both events in White patients were significantly lower than reference values.

    Conclusions The combination of harm data across hospitals with varying race and ethnicity collection systems was accomplished through iterative development of a race and ethnicity category framework. We identified racial and ethnic disparities in CLABSI and UE that can be addressed in future improvement work by identifying and modifying care delivery factors that contribute to safety disparities.

    • patient safety
    • collaborative, breakthrough groups
    • paediatrics

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    • Collaborators Collaborator group name: PHARE Cohort Study Group. Individual names: Emily Huffman, Dionne A Graham, Sara Green, Steven Viramontes, Margaret Richmond, Glenn Bushee, Kelly N Kennedy, Audrey H Barnett, Mary Saccoccio, Anu Partap, Carolina Typaldos, Rebecca Kerns, Kevin A Slavin, Corinne Corrigan, Robert J Gajarski, Caitlin McGrath, Angela Niesen, Kathryne H Basta, Jan Schriefer, Loreta Matheo, Laura Konkol, Raed M Khoury, Jeremy Santoro, John Andrew Young, Christine LeRoy, Laurel B Moyer, Charles G Macias, Tariq Chaudry.

    • Contributors AL, EH, MF, JDC, MG, KS, VW, LS, MM, MV, BF and MC made substantial contributions to the design of this work. PS, PC and US-B provided critical analysis and interpretation of the data. AL is the guarantor. All members of the PHARE Cohort Study Group were responsible for the acquisition of the data for this work. AL, EH, MF, JDC and MG were responsible for drafting the manuscript. All authors provided critical revisions of the final version of the manuscript and are accountable for all aspects of the work, including its integrity.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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