Addressing Health Disparities
Disparities in health outcomes have been well documented and received considerable attention in recent years. There is accumulating evidence that bias, racism and social determinants of health (SDOH) such as education, food accessibility, and housing instability may lead to disparate health outcomes among people of different races, ethnicities and income levels. The goal of the ADAPT Laboratory team is to identify and understand the causes of these disparities in order to develop solutions to improve healthcare for all.
The ADAPT Laboratory team has demonstrated that children often receive differential treatment based on their race and ethnicity with respect to pain management of conditions such as appendicitis and long bone fractures as well as in the receipt of sexual health services.
In addition, we demonstrated that patients and families are receptive to screening and intervention for SDOH in the E.D.. From 2017 to 2019, the Survey of Comprehensive Risk Evaluation and Emerging Needs (BearSCREEN) was used to survey over 1,000 caregivers and adolescents in the E.D. to assess unmet social needs and provide support. Nearly 40% of caregivers and 52% of adolescents surveyed reported at least three unmet needs.
Most recently, we identified racial/ethnic and socioeconomic disparities in SARS-CoV-2 positivity among children.
Improving Sexual Health Outcomes for Youth
Sexually transmitted infections (STIs) are prevalent among adolescents, and Washington, D.C., has one of the highest rates of STIs nationally. To address the high rates, the ADAPT Laboratory team developed a computerized Sexual Health Survey (SHS) to assess STI risk among adolescents. Supported by a National Institute of Child Health and Human Development K23 award, Monika Goyal, M.D., MSCE, found the SHS was acceptable to adolescents and demonstrated excellent test characteristics for predicting the risk of STI. In a randomized controlled trial, we demonstrated the provision of SHS-derived, paper-based, clinical decision support increased STI testing rates in a pediatric E.D. without interrupting clinical care or increasing E.D. length of stay. Building on this work and with the support of an NIH-funded R01 award, Dr. Goyal and her team are leveraging technology to increase STI testing among adolescents in the E.D.
Failure to diagnose and treat STIs in a timely manner can lead to pelvic inflammatory disease (PID), ectopic pregnancy, infertility, and facilitation of HIV transmission. Despite the mortality and morbidity associated with an STI diagnosis, we previously found less than 60% of patients had filled their prescriptions for treatment of STIs.
The ADAPT Laboratory team is committed to using technology, such as mobile health, to develop tools and interventions that will improve the sexual healthcare of adolescent E.D. patients.
Firearm Injury Prevention
Safer through Advocacy, Firearm Education and Research (SAFER) is a Firearm Injury Prevention Working Group at Children’s National Hospital. SAFER started as a conversation between several pediatric emergency medicine physicians who were discussing ways to reduce firearm injuries among youth. In the past 5 years, we have grown into a multidisciplinary team of over 40 clinicians and researchers with representation from Adolescent Health, Epidemiology and Biostatistics, Child Health Advocacy Institute, Emergency Medicine, Hospitalist Medicine, Outpatient Medicine and Psychiatry. We also collaborate with numerous colleagues across the country. We are dedicated to reducing firearm-related injuries and deaths in children through the application of strong research methods, education and advocacy. We have published 11 manuscripts, presented work at national and regional conferences and have coordinated outreach events with nonprofit community groups.
In previous work, we found that children in states with strict gun laws are less likely to die than children in states with less strict gun laws.
Read media coverage about this work:
- CNN: Children in states with strict gun laws are less likely to die, according to a new study
- USA Today: Fewer kids die from guns in states with stricter laws, study says
- PBS: Do gun safety laws decrease child deaths?
Most recently, the ADAPT Lab team identified racial/ethnic disparities in firearm mortality from legal interventions.
Read media coverage about this work: