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APPD/APA PHM Leadership SIG Confronting Racism Virtual Cafe: Systemic Racism Needs a Systematic Approach: Using QI as a framework - Shared screen with speaker view
Patricia Poitevien
Sick plan?
Magna Dias
How aggressively was his pain treated in the ED?
Jamie Pinto
Why is he drowsy? Pain is a powerful stimulant. I worry about stroke in a sickle cell patient
Jeremiah Cleveland
Was he treated as an opioid-naïve patient or someone who may have some tolerance to opioids and therefore need higher doses? People often judge what's a "high" dose without factoring in the patient's experience.
Edwn Zalneraitis
We have a clinical pathway across care areas for pain in SCD
Edwn Zalneraitis
Biggest threat we are encountering with regard to pain treatment in SCD are the application of DRGs to our pediatric population. This limits the number of days for which the hospital will be reimbursed, and we fear may result in inadequate treatment before discharge from te hospital. Although this applies to all, it affects the SCD population more than others.
Francisco Alvarez
The potential positive aspect of DRG based reimbursement could also be more attention to home and outpatient management improvements in order to minimize admissions and readmissions. I do agree that It is a bit of a double edged sword though.
Edwn Zalneraitis
Edwn Zalneraitis
The challenge is to upgrade our ambulatory/home game.
Francisco Alvarez
Very true. Ideally both outpatient and inpatient entities (if not under same organizational umbrella) would see a benefit in working together to improve the care of various patient populations.
sharon stoolman
pathway for pain for narcotic non naïve and that is shared with the patient
Ruchi Kaushik
I would add that the challenge is to advocate for the reimbursement for care coordination activities. When children/families of color (more likely to be on Medicaid, less likely to feel comfortable to advocate/coordinate care for themselves or with LEP) need this outpatient/inpatient coordination and it isn’t reimbursed well or at all, this itself poses a form of structural racism and inequities in outcome.
Edwn Zalneraitis
Properly implemented pathways to which all must adhere, might be a help in assuring equitable interventions, especially if there are consequences for those who do not follow the pathway.
Ruchi Kaushik
Certainly, it doesn’t mean that we as practitioners won’t engage in this coordination as it is the right thing for the patient/family, but as a complex care pediatrician caring for low income families, it is difficult for me to demonstrate to my institution what the value of my clinic is.
Magna Dias
I had a similar case recently but the issue was not the trainees who recognized the concern but the nurses who felt uncomfortable with dosing of the PCA despite cross check with the pain team and pharmacy.
Jamie Pinto
Does this clinical pathway address each individual's own opiod tolerance/individualized needs?
Patricia Poitevien
BMC has a great model for Health Equity Rounds where they review a case with their Dept directly related to discrimination and/or bias that has lead to a poor outcome for a patient / family https://www-ncbi-nlm-nih-gov.revproxy.brown.edu/pmc/articles/PMC7050660/
Edwn Zalneraitis
It should do so, and it should be evidence and outcome data based, reviewed regularly.
Edwn Zalneraitis
We can go back and correct or in some way compensate for the wrongs for events like occurred in Tulsa.
Ruchi Kaushik
Well said
Magna Dias
Great presentation. I have to drop off but thank you for raising this important issue in a QI framework
Ruchi Kaushik
This was an excellent presentation. Thank you so much for sharing. I have to move to another meeting but really enjoyed listening in.
Edwn Zalneraitis
Do you train residents and faculty in addressing escalation? CPI?
Francisco Alvarez
When you only have a hammer (i.e. one tool) everything looks like a nail
Jamie Pinto
Michael Bryant
Thank you Dr. Jackson - great presentation.
Megan McCabe
Thank you this was terrific!
Sheila Razdan
Thank you!!
Megan Aylor
thank you!