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
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.
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