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The SHEA Podcast | Taking Action: Identify & Address Disparities in Your IP Program · The SHEA Podcast

• 0:08
  SPEAKER_01: Welcome to Shay's Podcast.
• 0:10
  SPEAKER_01: We're excited to bring you today's podcast, Taking Action, Identify and Address the Disparities in Your Infection Prevention Program.
• 0:19
  SPEAKER_01: This is part of Shay's Revamped Podcast that will focus on Shay's mission of promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:35
  SPEAKER_01: We hope you will tune in as we continue to release new episodes this year.
• 0:40
  SPEAKER_01: I am Dr.
• 0:40
  SPEAKER_01: Amy John and I am currently a second-year ID Fellow at Montefire Medical Center.
• 0:47
  SPEAKER_01: As a member of the SHA Diversity, Equity and Inclusion Committee, I'm very pleased to serve as today's moderator as Dr.
• 0:54
  SPEAKER_01: Caitlin McGrath discusses her work on novel strategies to ensure equity in HAI prevention, the use of existing HAI surveillance systems to identify and mitigate inequities.
• 1:07
  SPEAKER_01: Dr.
• 1:07
  SPEAKER_01: McGrath is an associate professor of pediatric infectious diseases at University of Washington School of Medicine and Associate Medical Director of Infection Prevention at Seattle Children's Hospital.
• 1:20
  SPEAKER_01: Welcome, Dr.
• 1:21
  SPEAKER_01: McGrath.
• 1:22
  SPEAKER_01: Thanks for having me.
• 1:24
  SPEAKER_01: To start, what got you interested in disparities in infection prevention?
• 1:31
  SPEAKER_02: So for me, I was a pediatric infectious diseases fellow, maybe just like you, when our organization was starting this work.
• 1:38
  SPEAKER_02: And I would say their credit really goes to our hospitals diversity and health equity center, who, as part of a broader effort to look at many of our hospitals' quality and safety outcomes from a health equity lens, prompted us to look at our HAI data as well.
• 1:55
  SPEAKER_02: But what interested me in this work was really that it's an extension of what interested me in infection prevention work in general.
• 2:03
  SPEAKER_02: Our infection prevention and control and HAI prevention efforts are so crucial to facilitating that our patients get the health care that they need in a safe manner.
• 2:13
  SPEAKER_02: But we know that HDI prevention and infection prevention are certainly not immune from the inequities that are present within our broader healthcare system.
• 2:24
  SPEAKER_02: And for me, it was the consideration that if we are doing our IP and HDI prevention efforts better for some patients compared to others, then we as a field and as teams really have work to do to address that.
• 2:38
  SPEAKER_01: Dr.
• 2:39
  SPEAKER_01: McGrath, what do you think is the biggest disparity facing infection prevention programs?
• 2:46
  SPEAKER_02: That's a great question.
• 2:47
  SPEAKER_02: And I think that the answer may vary from organization to organization, but I would encourage organizations to just think about how the patients that you're serving may experience bias and discrimination, racism, and barriers to healthcare access and delivery.
• 3:05
  SPEAKER_02: And again, I think this will come back to listening to the various voices on your team and in your organization.
• 3:13
  SPEAKER_02: However, some of the ways that one can consider looking at this data from an equity lens is consider stratifying data by self-reported race and ethnicity, the language for which patients experience or require for healthcare delivery, sexual orientation and gender identity, disability status, insurance status, and even patient location in terms of rurality and how that may reflect access to care.
• 3:40
  SPEAKER_02: But when thinking about looking at your data from any kind of one of these variables or lenses, I think it's also really crucial for us to consider that these factors reflect only a subset of a person's identities.
• 3:52
  SPEAKER_02: And when one looks at the data through any single lens, that it doesn't reflect the intersectionality of various identities.
• 4:02
  SPEAKER_01: So often the problem seems so large, it's hard to know exactly where to start.
• 4:09
  SPEAKER_01: That's impactful and moves the program forward in a positive way.
• 4:14
  SPEAKER_01: Have you narrowed down all the things to identify areas to study?
• 4:21
  SPEAKER_02: Yeah, I think that's a really relatable feeling to feel just overwhelmed by the scope of inequities in healthcare.
• 4:29
  SPEAKER_02: The exactly where to start piece will likely vary from institution to institution, but I think there's a few key steps that can be really helpful regardless of the institution or organization.
• 4:41
  SPEAKER_02: Firstly, I think as people working in IP and HBI prevention, starting by just listening to others in the organization, whether it's community partners, equity content experts, and patients and families, and really listening to what concerns come to the forefront as areas to start.
• 5:02
  SPEAKER_02: This is also a great time to mention two aspects that for this work I think can help it to be most successful.
• 5:09
  SPEAKER_02: The first is having a multidisciplinary team with experts from many areas.
• 5:15
  SPEAKER_02: So folks mentioned just now in terms of community partners, equity content experts, and patients and families, as well as your frontline care providers and your analytics team.
• 5:25
  SPEAKER_02: And I think really acknowledging that as people working within infection prevention, we have this lens of expertise, but that we need these other lenses of expertise to do this work successfully.
• 5:37
  SPEAKER_02: And secondly, I would say that when knowing where to start, just starting somewhere is great because it will likely continue to build momentum in this work.
• 5:48
  SPEAKER_02: So starting somewhere by understanding your data, taking a look at your data, thinking about starting with perhaps just one HAI, and assessing where potential disparities may exist.
• 6:01
  SPEAKER_02: This will also involve thinking about where to start stratifying your data based on your variables of interest, which I hope that we'll get time to talk about as we go on further.
• 6:12
  SPEAKER_02: But would also really benefit from partnerships with those in your organization who have data analytics expertise.
• 6:22
  SPEAKER_01: You mentioned earlier about listening to your team and listening to those around you.
• 6:28
  SPEAKER_01: Specifically, how do you get buy-in for these studies and then implementation?
• 6:36
  SPEAKER_02: So I think having that multidisciplinary team can hopefully be a good start.
• 6:41
  SPEAKER_02: For us, that team has also included support from our executive leadership team.
• 6:47
  SPEAKER_02: And I would say that's been really crucial in building in time set aside for people to focus on this work and have this work be seen really not as an extra, but something that's built into priorities for the organization and for the infection prevention program.
• 7:05
  SPEAKER_02: So, for instance, for our CLABC program, and work related to equity in our collabsea prevention efforts is really built into the program's priorities and goals.
• 7:16
  SPEAKER_02: And I think that means that people feel like they can set aside time to look at the data, talk with patients, families, et cetera, others who have a voice here to move the work forward.
• 7:29
  SPEAKER_02: But that first piece with getting your leaders to support that can be crucial.
• 7:35
  SPEAKER_01: And you talked earlier about first putting your team together and then you have your data.
• 7:44
  SPEAKER_01: With that data, what key metrics should be considered when evaluating the effectiveness of infection prevention efforts across different demographics.
• 7:56
  SPEAKER_02: Again, I think starting with just one HAI can be really helpful to develop a process for doing this work before expanding to other HAIs.
• 8:05
  SPEAKER_02: And then really, I think thinking about the variables of interest to your program, your organization, and your team, which hopefully will come from all of those voices that we mentioned earlier.
• 8:20
  SPEAKER_02: One of the references that I really like kind of speaking to this process more generally, that hopefully we can maybe link in show notes or other resources, is by Dr.
• 8:30
  SPEAKER_02: Lyon et al.
• 8:31
  SPEAKER_02: And it's titled, All Quality Improvement is Health Equity Work.
• 8:35
  SPEAKER_02: There's a figure in that paper, and that to me is a great motivator for thinking about why we need to both stratify our data when we're starting and then continue to track this over time.
• 8:47
  SPEAKER_02: Because our QI efforts can continue propagating a disparity that already exists, or they can widen or narrow a disparity.
• 8:56
  SPEAKER_02: Of course, we hope that our efforts can narrow or even eliminate a particular disparity.
• 9:01
  SPEAKER_02: But if we're not tracking our metric of interest by the factors that affect our disparity, then we may not recognize if our efforts have the intended effect or potentially unintended negative effects.
• 9:18
  SPEAKER_02: And I think to me, it also demonstrates why we should look at really all of our QI efforts from an equity lens to ensure that they're not having unintended effects of widening inequities.
• 9:30
  SPEAKER_01: I like that saying.
• 9:54
  SPEAKER_02: Yeah, I'd love to talk about some of the work that we've done and some of the work that I think that we're you're learning from others about as well.
• 10:00
  SPEAKER_02: So at our organization, we began stratifying our CLABC rates by patient and family self-reported race and ethnicity, as well as language for medical care.
• 10:11
  SPEAKER_02: We recognized that those were only a subset of some of the ways that we can and should look at our data, but for us it was a great starting place.
• 10:22
  SPEAKER_02: We identified disparately high CLABC rates for patients who are self-identified as black or African American and for those who use a language other than English for medical care.
• 10:32
  SPEAKER_02: Using that multidisciplinary team and work that was informed by everyone on that team, we were able to design some equity-focused QI interventions and then show improvement in these inequities.
• 10:47
  SPEAKER_02: I should also note that while we were embarking on some of those interventions, we also did some additional work to show that these disparities that we identified persisted after adjusting for many patient and line factors that affect CLABC risk.
• 11:03
  SPEAKER_02: For us, this demonstrated that these were unjust and preventable inequities.
• 11:08
  SPEAKER_02: And I think it helped everyone to have kind of a shared model of how to think about these disparities as being unjust and preventable.
• 11:16
  SPEAKER_02: Another exciting component that for us locally has resulted from this work is just a general increase in how we incorporate patient and family perspectives in all aspects of our collabs prevention work, which has resulted in some new innovations brought up by patient and family ideas that I think are things our team alone would not have identified as areas to work on.
• 11:42
  SPEAKER_02: So that's been really valuable.
• 11:44
  SPEAKER_02: Beyond what we've done locally, another example that I find exciting and I'll highlight related to this work is how our infection prevention education can better serve the needs of patients who speak a language other than English.
• 11:57
  SPEAKER_02: There was a recent commentary by Dr.
• 11:59
  SPEAKER_02: Prochaska et al.
• 12:00
  SPEAKER_02: in Itchy that addressed this and gave some background as well as some ideas.
• 12:05
  SPEAKER_02: And I think that there's pieces of this work that really every hospital and IP program can consider implementing in their own work, even again if it's starting somewhere small, but improving the ways that they allow patients and families to access the education that they provide.
• 12:24
  SPEAKER_01: I like how you mention the inclusion of patients' families into this discussion.
• 12:32
  SPEAKER_01: While it's not something that's completely novel, just you including it in your efforts has shown to help.
• 12:42
  SPEAKER_01: But outside of that, what would you like to see in the future as infection prevention programs tackle the issue of health disparities?
• 12:50
  SPEAKER_02: Yeah, I think it's exciting that more and more people within our field are having conversations like this and are interested in this work.
• 12:57
  SPEAKER_02: And I think that there's some concrete actions that will continue to move this work forward in our field.
• 13:04
  SPEAKER_02: Some of those include broader opportunities for information and experience sharing among organizations.
• 13:12
  SPEAKER_02: And from the analytics side, having some standardized definitions, data fields for collection and analysis tools will allow organizations to learn from each other and not have to reinvent this process at each individual organization.
• 13:28
  SPEAKER_02: I also think that organizations like Shea can advocate for why this work is important.
• 13:33
  SPEAKER_02: And I hope that that advocacy could lead to teams having the support that they need for the time and tools to do this work as part of their program priorities.
• 13:46
  SPEAKER_02: Further, I think the advocacy for our national surveillance networks to collect data fields which would allow us to look at our data both locally and nationally from an equity lens will be really important.
• 13:59
  SPEAKER_01: Thank you very much, Dr.
• 14:01
  SPEAKER_01: McGrath, for sharing your experiences.
• 14:04
  SPEAKER_02: Thank you for the conversation and really grateful to Shay for providing a platform for us to talk about this work and hope that it can be a continuation of further conversations to come.
• 14:19
  SPEAKER_01: That concludes this episode of the Shay Podcast.
• 14:22
  SPEAKER_01: Thank you for tuning in.
• 14:23
  SPEAKER_01: If you aren't a member of Shay, consider joining in 2024.
• 14:27
  SPEAKER_01: Check out www.shay-online.org for more information about how to get involved.
• 14:34
  SPEAKER_01: If you need help, email us at infoshayonline.org.
• 14:39
  SPEAKER_01: Happy New Year.
• 14:41
  SPEAKER_00: Thanks for listening to today's episode of the Shea Podcast.
• 14:45
  SPEAKER_00: Don't forget to register for the 2024 Shea Spring Conference, taking place April 16th to the 19th in Houston, Texas.
• 14:53
  SPEAKER_00: For more information and to register, visit Shayspring.org.