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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
23:17
Sick plan?
Magna Dias
24:13
How aggressively was his pain treated in the ED?
Jamie Pinto
25:02
Why is he drowsy? Pain is a powerful stimulant. I worry about stroke in a sickle cell patient
Jeremiah Cleveland
26:04
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
28:18
We have a clinical pathway across care areas for pain in SCD
Edwn Zalneraitis
34:06
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
36:11
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
37:22
Agree
Edwn Zalneraitis
37:55
The challenge is to upgrade our ambulatory/home game.
Francisco Alvarez
39:18
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
41:07
pathway for pain for narcotic non naïve and that is shared with the patient
Ruchi Kaushik
41:25
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
41:35
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
43:03
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
43:20
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
46:04
Does this clinical pathway address each individual's own opiod tolerance/individualized needs?
Patricia Poitevien
47:14
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
47:22
It should do so, and it should be evidence and outcome data based, reviewed regularly.
Edwn Zalneraitis
49:49
We can go back and correct or in some way compensate for the wrongs for events like occurred in Tulsa.
Ruchi Kaushik
52:22
Well said
Magna Dias
53:40
Great presentation. I have to drop off but thank you for raising this important issue in a QI framework
Ruchi Kaushik
54:54
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
56:03
Do you train residents and faculty in addressing escalation? CPI?
Francisco Alvarez
56:26
When you only have a hammer (i.e. one tool) everything looks like a nail
Jamie Pinto
01:08:36
Thank-you!
Michael Bryant
01:08:43
Thank you Dr. Jackson - great presentation.
Megan McCabe
01:08:48
Thank you this was terrific!
Sheila Razdan
01:08:56
Thank you!!
Megan Aylor
01:08:57
thank you!