Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol
Introduction The management of low-risk febrile infants presents a model population for exploring how implicit racial bias promotes inequitable emergency care for children who belong to racial, ethnic and language minority groups. Although widely used clinical standards guide the clinical care of fe...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/9/e063611.full |
| _version_ | 1811341219046883328 |
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| author | Rosemarie Fernandez Carma Bylund Mary D Patterson Colleen K Gutman K Casey Lion Paul Aronson Carla Fisher Antionette McFarlane Xiangyang Lou Ahmed Lababidi |
| author_facet | Rosemarie Fernandez Carma Bylund Mary D Patterson Colleen K Gutman K Casey Lion Paul Aronson Carla Fisher Antionette McFarlane Xiangyang Lou Ahmed Lababidi |
| author_sort | Rosemarie Fernandez |
| collection | DOAJ |
| description | Introduction The management of low-risk febrile infants presents a model population for exploring how implicit racial bias promotes inequitable emergency care for children who belong to racial, ethnic and language minority groups. Although widely used clinical standards guide the clinical care of febrile infants, there remains substantial variability in management strategies. Deviations from recommended care may be informed by the physician’s assessment of the family’s values, risk tolerance and access to supportive resources. However, in the fast-paced emergency setting, such assessments may be influenced by implicit racial bias. Despite significant research to inform the clinical care of febrile infants, there is a dearth of knowledge regarding health disparities and clinical guideline implementation. The proposed mixed methods approach will (1) quantify the extent of disparities by race, ethnicity and language proficiency and (2) explore the role of implicit bias in physician–patient communication when caring for this population.Methods and analysis With 42 participating sites from the Pediatric Emergency Medicine Collaborative Research Committee, we will conduct a multicenter, cross-sectional study of low-risk febrile infants treated in the emergency department (ED) and apply multivariable logistic regression to assess the association between (1) race and ethnicity and (2) limited English proficiency with the primary outcome, discharge to home without lumbar puncture or antibiotics. We will concurrently perform an interpretive study using purposive sampling to conduct individual semistructured interviews with (1) minority parents of febrile infants and (2) paediatric ED physicians. We will triangulate or compare perspectives to better elucidate disparities and bias in communication and medical decision-making.Ethics and dissemination This study has been approved by the University of Florida Institutional Review Board. All participating sites in the multicenter analysis will obtain local institutional review board approval. The results of this study will be presented at academic conferences and in peer-reviewed publications. |
| first_indexed | 2024-04-13T18:54:18Z |
| format | Article |
| id | doaj.art-1e827e813eb04796a5b84fc4a20135b0 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-13T18:54:18Z |
| publishDate | 2022-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-1e827e813eb04796a5b84fc4a20135b02022-12-22T02:34:19ZengBMJ Publishing GroupBMJ Open2044-60552022-09-0112910.1136/bmjopen-2022-063611Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocolRosemarie Fernandez0Carma Bylund1Mary D Patterson2Colleen K Gutman3K Casey Lion4Paul Aronson5Carla Fisher6Antionette McFarlane7Xiangyang Lou8Ahmed Lababidi9Department of Emergency Medicine, University of Florida, Gainesville, Florida, USADepartment of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USADepartment of Emergency Medicine, University of Florida, Gainesville, Florida, USADepartment of Emergency Medicine, University of Florida, Gainesville, Florida, USADepartment of Pediatrics, University of Washington, Seattle, Washington, USADepartments of Emergency Medicine and Pediatrics, Yale University, New Haven, Connecticut, USACollege of Journalism and Communications, University of Florida, Gainesville, Florida, USADepartment of Emergency Medicine, University of Florida, Gainesville, Florida, USADepartment of Biostatistics, University of Florida, Gainesville, Florida, USADepartment of Pediatrics, University of Florida, Gainesville, Florida, USAIntroduction The management of low-risk febrile infants presents a model population for exploring how implicit racial bias promotes inequitable emergency care for children who belong to racial, ethnic and language minority groups. Although widely used clinical standards guide the clinical care of febrile infants, there remains substantial variability in management strategies. Deviations from recommended care may be informed by the physician’s assessment of the family’s values, risk tolerance and access to supportive resources. However, in the fast-paced emergency setting, such assessments may be influenced by implicit racial bias. Despite significant research to inform the clinical care of febrile infants, there is a dearth of knowledge regarding health disparities and clinical guideline implementation. The proposed mixed methods approach will (1) quantify the extent of disparities by race, ethnicity and language proficiency and (2) explore the role of implicit bias in physician–patient communication when caring for this population.Methods and analysis With 42 participating sites from the Pediatric Emergency Medicine Collaborative Research Committee, we will conduct a multicenter, cross-sectional study of low-risk febrile infants treated in the emergency department (ED) and apply multivariable logistic regression to assess the association between (1) race and ethnicity and (2) limited English proficiency with the primary outcome, discharge to home without lumbar puncture or antibiotics. We will concurrently perform an interpretive study using purposive sampling to conduct individual semistructured interviews with (1) minority parents of febrile infants and (2) paediatric ED physicians. We will triangulate or compare perspectives to better elucidate disparities and bias in communication and medical decision-making.Ethics and dissemination This study has been approved by the University of Florida Institutional Review Board. All participating sites in the multicenter analysis will obtain local institutional review board approval. The results of this study will be presented at academic conferences and in peer-reviewed publications.https://bmjopen.bmj.com/content/12/9/e063611.full |
| spellingShingle | Rosemarie Fernandez Carma Bylund Mary D Patterson Colleen K Gutman K Casey Lion Paul Aronson Carla Fisher Antionette McFarlane Xiangyang Lou Ahmed Lababidi Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol BMJ Open |
| title | Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol |
| title_full | Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol |
| title_fullStr | Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol |
| title_full_unstemmed | Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol |
| title_short | Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol |
| title_sort | disparities and implicit bias in the management of low risk febrile infants a mixed methods study protocol |
| url | https://bmjopen.bmj.com/content/12/9/e063611.full |
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