149 A Mixed Methods Analysis of Disparities in the Management of Low-Risk Febrile Infants
OBJECTIVES/GOALS: Febrile infants are a model population for exploring communication, implicit bias, and health disparities in the pediatric emergency department. Using mixed methods, we performed an in-depth analysis of disparities and physician-parent communication, a potentially modifiable driver...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2023-04-01
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| Series: | Journal of Clinical and Translational Science |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2059866123002303/type/journal_article |
| _version_ | 1797840470870589440 |
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| author | Colleen Gutman Paul Aronson K. Casey Lion Carla Fisher Antionette McFarlane Carma Bylund Rosemarie Fernandez |
| author_facet | Colleen Gutman Paul Aronson K. Casey Lion Carla Fisher Antionette McFarlane Carma Bylund Rosemarie Fernandez |
| author_sort | Colleen Gutman |
| collection | DOAJ |
| description | OBJECTIVES/GOALS: Febrile infants are a model population for exploring communication, implicit bias, and health disparities in the pediatric emergency department. Using mixed methods, we performed an in-depth analysis of disparities and physician-parent communication, a potentially modifiable driver of inequities. METHODS/STUDY POPULATION: We performed a multicenter cross-sectional study of febrile infants with low-risk for invasive bacterial infection evaluated between 2018-19 across 32 institutions. We performed logistic regression to assess the association between 1) race and ethnicity (Non-Hispanic White [NHW], Non-Hispanic Black [NHB], Hispanic [H], Other Race and/or Ethnicity [O]) and 2) limited English proficiency (LEP) with the standard of care, discharge without lumbar puncture and without antibiotics. We concurrently performed in-depth semi-structured interviews with physicians to explore physician–parent communication and implicit bias in the management decisions for febrile infants. RESULTS/ANTICIPATED RESULTS: Of 3629 low-risk febrile infants, 74.2% received standard of care. NHB, compared to NHW, infants were more likely to receive standard of care (aOR 1.3 [95% CI 1.0-1.7]; aOR H: 1.1 [95% CI 0.9-1.4]; aOR O: 1.0 [95%CI 0.8-1.4]). There was no association between LEP and standard of care (aOR 0.8 [0.61–1.1]). When accounting for documented use of professional interpretation, families with LEP without documented professional interpretation were less likely than families without LEP to receive standard of care (aOR 0.6 [95% CI 0.4–0.9]). Thematic analysis of 13 physician interviews is expected to elucidate aspects of the physician-parent interaction that influence management decisions. DISCUSSION/SIGNIFICANCE: Infant race, ethnicity, and use of professional interpretation, are associated with the management of low-risk febrile infants. Physician behaviors that are influenced by the physician-parent interaction may represent modifiable targets for future interventions to promote health equity. |
| first_indexed | 2024-04-09T16:15:51Z |
| format | Article |
| id | doaj.art-4add250acc454dae9abcff64a64fe7d5 |
| institution | Directory Open Access Journal |
| issn | 2059-8661 |
| language | English |
| last_indexed | 2024-04-09T16:15:51Z |
| publishDate | 2023-04-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Journal of Clinical and Translational Science |
| spelling | doaj.art-4add250acc454dae9abcff64a64fe7d52023-04-24T05:55:55ZengCambridge University PressJournal of Clinical and Translational Science2059-86612023-04-017454510.1017/cts.2023.230149 A Mixed Methods Analysis of Disparities in the Management of Low-Risk Febrile InfantsColleen Gutman0Paul Aronson1K. Casey Lion2Carla Fisher3Antionette McFarlane4Carma Bylund5Rosemarie Fernandez6University of FloridaYale UniversityUniversity of WashingtonUniversity of FloridaUniversity of FloridaUniversity of FloridaUniversity of FloridaOBJECTIVES/GOALS: Febrile infants are a model population for exploring communication, implicit bias, and health disparities in the pediatric emergency department. Using mixed methods, we performed an in-depth analysis of disparities and physician-parent communication, a potentially modifiable driver of inequities. METHODS/STUDY POPULATION: We performed a multicenter cross-sectional study of febrile infants with low-risk for invasive bacterial infection evaluated between 2018-19 across 32 institutions. We performed logistic regression to assess the association between 1) race and ethnicity (Non-Hispanic White [NHW], Non-Hispanic Black [NHB], Hispanic [H], Other Race and/or Ethnicity [O]) and 2) limited English proficiency (LEP) with the standard of care, discharge without lumbar puncture and without antibiotics. We concurrently performed in-depth semi-structured interviews with physicians to explore physician–parent communication and implicit bias in the management decisions for febrile infants. RESULTS/ANTICIPATED RESULTS: Of 3629 low-risk febrile infants, 74.2% received standard of care. NHB, compared to NHW, infants were more likely to receive standard of care (aOR 1.3 [95% CI 1.0-1.7]; aOR H: 1.1 [95% CI 0.9-1.4]; aOR O: 1.0 [95%CI 0.8-1.4]). There was no association between LEP and standard of care (aOR 0.8 [0.61–1.1]). When accounting for documented use of professional interpretation, families with LEP without documented professional interpretation were less likely than families without LEP to receive standard of care (aOR 0.6 [95% CI 0.4–0.9]). Thematic analysis of 13 physician interviews is expected to elucidate aspects of the physician-parent interaction that influence management decisions. DISCUSSION/SIGNIFICANCE: Infant race, ethnicity, and use of professional interpretation, are associated with the management of low-risk febrile infants. Physician behaviors that are influenced by the physician-parent interaction may represent modifiable targets for future interventions to promote health equity.https://www.cambridge.org/core/product/identifier/S2059866123002303/type/journal_article |
| spellingShingle | Colleen Gutman Paul Aronson K. Casey Lion Carla Fisher Antionette McFarlane Carma Bylund Rosemarie Fernandez 149 A Mixed Methods Analysis of Disparities in the Management of Low-Risk Febrile Infants Journal of Clinical and Translational Science |
| title | 149 A Mixed Methods Analysis of Disparities in the Management of Low-Risk Febrile Infants |
| title_full | 149 A Mixed Methods Analysis of Disparities in the Management of Low-Risk Febrile Infants |
| title_fullStr | 149 A Mixed Methods Analysis of Disparities in the Management of Low-Risk Febrile Infants |
| title_full_unstemmed | 149 A Mixed Methods Analysis of Disparities in the Management of Low-Risk Febrile Infants |
| title_short | 149 A Mixed Methods Analysis of Disparities in the Management of Low-Risk Febrile Infants |
| title_sort | 149 a mixed methods analysis of disparities in the management of low risk febrile infants |
| url | https://www.cambridge.org/core/product/identifier/S2059866123002303/type/journal_article |
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