Evidence of health disparities affecting newborns abounds. Although quality improvement (QI) methodology is often suggested as a tool to advance health equity, the impact of QI initiatives on disparities is variable. QI work may mitigate, worsen, or perpetuate existing disparities. QI projects designed without an intentional focus on equity promotion may foster intervention-generated inequalities that further disadvantage vulnerable groups. This article reviews disparities in perinatal and neonatal care, the impact of QI on health disparities, and the concept of "Equity-Focused Quality Improvement" (EF-QI). EF-QI differs from QI with an equity lens in that it is action-oriented and centered around equity. EF-QI initiatives purposely integrate equity throughout the fabric of the project and are inclusive, collaborative efforts that foreground and address the needs of disadvantaged populations. EF-QI principles are applicable at every stage of project conception, execution, analysis, and dissemination, and may provide opportunities for reducing disparities in neonatal care.

Using rising tides to lift all boats: Equity-focused quality improvement as a tool to reduce neonatal health disparities.

BACKGROUND AND OBJECTIVES
Black preterm infants are more likely to die than White preterm infants within the same NICU. Racism may lead to disparate quality of NICU care contributing to disparities in preterm infant health outcomes. The objective of our study was to understand Black mothers' perspectives of the impact of racism on the quality of care for Black preterm infants in the NICU and what might be done to address it.


METHODS
Using qualitative research methods, we conducted in-depth, semistructured interviews with 20 Black mothers of preterm infants in a single Level IV NICU 6 to 18 months after hospital discharge regarding experiences with disparate quality of NICU care. We developed themes iteratively and conducted interviews until thematic saturation was reached.


RESULTS
The majority of mothers believed that racism impacted the quality of NICU care and described examples of racism in the NICU at structural, institutional, and interpersonal levels. Mothers also provided ideas for interventions that would decrease racism and improve quality of NICU care for Black families, including increased Black representation, increased peer support, and improved staff education and training.


CONCLUSIONS
Black mothers of preterm infants experienced racism during NICU hospitalization that impacted the quality of care they received. Interventional studies directed toward mitigating these racial disparities may focus on addressing racism during the NICU period and should include input from Black stakeholders at all stages of design, implementation, and analysis.

Racism and Quality of Neonatal Intensive Care: Voices of Black Mothers.

Neonatal patients and families from historically marginalized and discriminated communities have long been documented to have differential access to health care, disparate health care, and as a result, inequitable health outcomes. Fundamental to these processes is an understanding of what race and ethnicity represent for patients and how different levels of racism act as social determinants of health. The NICU presents a unique opportunity to intervene with regard to the detrimental ways in which structural, institutional, interpersonal, and internalized racism affect the health of newborn infants. The aim of this article is to provide neonatal clinicians with a foundational understanding of race, racism, and antiracism within medicine, as well as concrete ways in which health care professionals in the field of neonatology can contribute to antiracism and health equity in their professional careers.

Antiracism in the Field of Neonatology: A Foundation and Concrete Approaches.

Racism and pediatric health outcomes.

"funds flow" implementation at academic health centers- unique challenges to pediatric departments.

Health disparities have been documented across the economic spectrum and around the globe for decades; they are a major societal problem.1 Health disparities parities among children are particularly important because of their long-term impact on important outcomes, such as adult health, educational attainment, and economic success.2,3 There has been a growing awareness that addressing health disparities extends beyond documenting group-based differences in health outcomes and requires an exploration of the inequalities on which they are founded, often long-standing structural racism and social injustice.2,4 As a result, the idea of progressing toward and achieving “health equity” has gained visibility. There is also increasing recognition that the concept of health equity applies to health policy, health systems, and the professional scope of responsibilities as-signed to clinicians, medical educators, researchers, health administrators, public health professionals, and legislators.

Michelle-Marie Peña

Papers

Using rising tides to lift all boats: Equity-focused quality improvement as a tool to reduce neonatal health disparities.

In Pursuit of Health Equity in Pediatrics.