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Objectives We sought to create a computational pipeline for attaching geomarkers, contextual or geographic measures that influence or predict health, to electronic health records at scale, including developing a tool for matching addresses to parcels to assess the impact of housing characteristics on pediatric health. Materials and Methods We created a geomarker pipeline to link residential addresses from hospital admissions at Cincinnati Children's Hospital Medical Center (CCHMC) between July 2016 and June 2022 to place-based data. Linkage methods included by date of admission, geocoding to census tract, street range geocoding, and probabilistic address matching. We assessed 4 methods for probabilistic address matching. Results We characterized 124 244 hospitalizations experienced by 69 842 children admitted to CCHMC. Of the 55 684 hospitalizations with residential addresses in Hamilton County, Ohio, all were matched to 7 temporal geomarkers, 97% were matched to 79 census tract-level geomarkers and 13 point-level geomarkers, and 75% were matched to 16 parcel-level geomarkers. Parcel-level geomarkers were linked using our exact address matching tool developed using the best-performing linkage method. Discussion Our multimodal geomarker pipeline provides a reproducible framework for attaching place-based data to health data while maintaining data privacy. This framework can be applied to other populations and in other regions. We also created a tool for address matching that democratizes parcel-level data to advance precision population health efforts. Conclusion We created an open framework for multimodal geomarker assessment by harmonizing and linking a set of over 100 geomarkers to hospitalization data, enabling assessment of links between geomarkers and hospital admissions. [ABSTRACT FROM AUTHOR]

Objective: Worsening rates of infant and maternal mortality in the United States serve as an urgent call for multi-modal intervention. Infant Well Child Visits (WCVs) provide an opportunity for prevention, however not all infants receive the recommended schedule of visits, with infants of low-income and Black families missing a higher portion of WCVs. Due to diverse experiences and needs of under-resourced communities throughout the United States, caregiver voice is essential when designing improvement efforts. Methods: Purposeful sampling and interviewing of 10 caregivers in Cincinnati, OH was performed by community peer researchers. Interview transcripts were evaluated by the research team, with identification of several important themes. Results: Nine out of 10 caregivers self-identified as Black. All young children of the interviewed caregivers had Medicaid as their insurance provider. All interviews highlighted rich perspectives on caregiver hopes for their child, family, and selves. Establishing trust through empathy, shared decision making, and the nurturing of interpersonal patient-practitioner relationships is crucial for fostering a positive healthcare experience. Levels of mistrust was perceptibly high across several interviews, with lack of racial concordance between medical provider and family exacerbating the issue for some caregivers. Caregivers voiced a tendency to rely on family and community members for when to seek out health care for their children, and additionally cited racism and perceptions of being rushed or judged as barriers to seeking further care. Conclusion: This study emphasizes the importance of being community-informed when considering interventions. Prior research on the topic of missed WCV's often focused on material resource availability and limitations. While that was commented on by caregivers in this study as well, equal—if not more—attention was directed toward interpersonal relationship formation, the presence or absence of trust between practitioner and caregiver, and the importance of social-emotional support for caregivers. We highlight several opportunities for systemic improvements as well as future directions for research. [ABSTRACT FROM AUTHOR]

Medical-legal partnerships connect legal advocates to healthcare providers and settings. Maintaining effectiveness of medical-legal partnerships and consistently identifying opportunities for innovation and adaptation takes intentionality and effort. In this paper, we discuss ways in which our use of data and quality improvement methods have facilitated advocacy at both patient (client) and population levels as we collectively pursue better, more equitable outcomes. [ABSTRACT FROM AUTHOR]

Children who identify as Black or multiracial report significantly higher exposure to adverse childhood experiences, which places them at greater risk for poor mental and physical health outcomes. These disparities and increasing awareness of racism as an adverse childhood experience has resulted in the American Academy of Pediatrics, American Psychological Association, and other groups declaring racism a public health crisis. To provide high-quality care, providers who engage with patients and families impacted by systemic racism must be aware of its role in health disparities. This requires clinicians to have the knowledge and skills to discuss racism with colleagues, patients, and families. To promote clinicians' competence to engage in these discussions, this article 1) sensitizes providers to historical and contextual factors that inform experiences with anti-Black racism and health disparities and 2) offers strategies to address anti-Black racism in clinical care.Embracing the process of brave, informed conversations about race represents a pathway for building trust between providers and patients, a key component of various health outcomes. Additionally, these foundational skills of reflection, cultural humility, and bias recognition will be needed to engage in allyship and advocacy both within and beyond the exam room. [ABSTRACT FROM AUTHOR]

The article focuses on innovative approaches to combat racism in medical education, featuring 11 educational innovations aimed at creating antiracist clinical and learning environments for medical learners. Topics include levels of racism addressed (personally-mediated and institutional), curriculum dissemination across a continuum of learners, and the use of diverse modalities to foster discussion and community in antiracism education.

In 2019, just one-half of Americans received their influenza vaccine, despite it being safe, effective, and important in preventing serious infection, hospitalization, and death. Black children receive fewer influenza vaccines than their White counterparts. Vaccine hesitancy can hinder influenza vaccine uptake and is partially fueled by ongoing systemic racism and historical abuse leading to medical mistrust in communities of color. Building trust may enhance the transfer of reliable vaccine information and may move people along the spectrum of vaccine intention. We sought to partner with faith-based organizations through a community influenza vaccination event to increase vaccination rates. By leveraging the reach and expertise of trusted voices, such as church "first ladies" and local community leaders, we were able to administer 600 pediatric influenza vaccines between 2016 and 2019. In addition, this event served as a platform to assess whether youth attendees had a place for regular medical care ("medical home") (>80% did in each year assessed) and to conduct preventive screenings. Most children, as reported by their caregivers, had recent medical check-ups (85% in 2016, 84% in 2017, and 82% in 2018). Of the children screened, more than one-third had an abnormal body mass index and one-half had abnormal dentition. By partnering with organizations that are well-embedded in the local community, such as faith-based organizations, health care groups may be able to maximize the impact of their health promotion campaigns. [ABSTRACT FROM AUTHOR]

The article focuses on the challenges, consequences, and potential solutions related to diversity, equity, and inclusion (DEI) in pediatrics, with specific attention to the impact of state-level legislation restricting DEI initiatives. Topics include the increasing importance of DEI in pediatric academic and clinical settings, the adverse effects of anti-DEI legislation, and the necessary collaborative efforts.

Competing Interests: Declaration of Competing Interest none

Objective: To qualitatively understand and characterize the experience of racism in outpatient pediatric healthcare settings from the perspectives of Black families., Methods: We conducted focus groups with parents or guardians of Black children, recruited from academic primary care offices at a single pediatric institution. Focus groups were facilitated virtually by Black team members using an open-ended, semi-structured focus group guide. We analyzed focus group transcripts using iterative, thematic, inductive open coding performed independently by trained coders, with final codes reached by group consensus., Results: We conducted 6 focus groups of 3 to 5 participants each and 1 individual interview, with 24 total parents. We identified the following themes: 1) "I just felt like we was a number": Black families perceived experiences that felt impersonal and lacked empathy; 2) "Why is the doctor treating me like I don't matter?": Black families perceived experiences with poor care and worse treatment; 3) Black families experience racism across socioecological levels when interacting with pediatric health systems; 4) Positive perceived experiences can guide improvement; and 5) Improvement will require antiracist efforts across the levels of racism., Conclusions: In this qualitative study, we found that Black families have had many poor pediatric experiences, perceive racism as affecting child health broadly across socioecological levels, and recommend a multidimensional antiracist approach to improvement. Our findings underscore the importance of elevating Black family voices in developing policies that prioritize antiracism and work to eliminate the harmful impacts of racism on child health., Competing Interests: Declaration of Competing Interest None., (Copyright © 2025 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Although many pediatric clinicians have familiarity with motivational interviewing (MI), they may have limited awareness of how it can benefit mental and behavioral health assessment and management. This article describes the spirit, tasks, and skills of MI. Cases illustrate the application of MI to common presentations of mental health concerns in pediatric primary care. These examples provide concrete guidance on how to navigate barriers to applying MI and underscore how MI aligns with the unique opportunities and values of primary care, including longitudinal relationships, opportunities to partner with families in shared decision-making, and valuing culturally-responsive, patient-centered care., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Using a structural racism framework, we assessed racial inequities in continuity of care, using the Usual Provider Continuity Index (UPC - the proportion of visits with the provider the patient saw most frequently out of all visits), in a set of large pediatric academic clinics., Methods: We conducted a retrospective cohort study. Patients 12-24 months seen at three pediatric academic primary care clinics for any visit during October 1-31, 2021 were included. We then reviewed continuity for these patients in the preceding 12 months. Outcomes included each patient's UPC for all visits, and a modified UPC for well child checks only (UPC Well). Covariates included race, ethnicity, insurance, clinic site, age, sex, care management, or seeing a social worker. We evaluated for differences in outcomes using bivariate analyses and multivariable regression models., Results: Our cohort included 356 patients (74% Black, 5% Hispanic, 85% Medicaid, 52% female, median age 15.8 months). The median UPC was 0.33 and median UPC Well was 0.40. Black patients had significantly lower median values for UPC (0.33 Black vs 0.40 non-Black, P < .01) and UPC Well (0.33 Black vs 0.50 non-Black, P < .01). There were similar inequities in continuity rates by insurance and clinic site. In multivariable models, clinic site was the only variable significantly associated with continuity., Conclusions: Clinic sites serving higher percentages of Black patients had lower rates of continuity. The main driver of racial inequities in continuity rates was at the institutional level., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate whether racial and socioeconomic inequities in pediatric palliative care utilization extend to children with high-intensity neurologic impairment (HI-NI), which is a chronic neurological diagnosis resulting in substantial functional morbidity and mortality., Study Design: We conducted a retrospective study of patients with HI-NI who received primary care services at a tertiary care center from 2014 through 2019. HI-NI diagnoses that warranted a palliative care referral were identified by consensus of a multidisciplinary team. The outcome was referral to palliative care. The primary exposure was race, categorized as Black or non-Black to represent the impact of anti-Black racism. Additional exposures included ethnicity (Hispanic/non-Hispanic) and insurance status (Medicaid/non-Medicaid). Descriptive statistics, bivariate analyses, and multivariable logistic regression models were performed to assess associations between exposures and palliative care referral., Results: A total of 801 patients with HI-NI were included; 7.5% received a palliative referral. There were no differences in gestational age, sex, or ethnicity between patients who received a referral and those who did not. In multivariable analysis, adjusting for ethnicity, sex, gestational age, and presence of complex chronic conditions, Black children (aOR 0.47, 95% CI 0.26, 0.84) and children with Medicaid insurance (aOR 0.40, 95% CI 0.23, 0.70) each had significantly lower odds of palliative referral compared with their non-Black and non-Medicaid-insured peers, respectively., Conclusions: We identified inequities in pediatric palliative care referral among children with HI-NI by race and insurance status. Future work is needed to develop interventions, with families, aimed at promoting more equitable, antiracist systems of palliative care., Competing Interests: Declaration of Competing Interest This project was supported by funds from the Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS), under National Research Service Award (NRSA) grant number T32HP10027, General Pediatrics Research Fellowship in Child and Adolescent Health, total award amount $2,432,131. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the BHPr, HRSA, DHHS or the U.S. Government. The other authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Learning more about resident characteristics, career choices, job search experiences, and satisfaction for different racial and ethnic backgrounds can inform needs and approaches to diversifying the physician workforce., Methods: We analyzed survey data collected from national random samples of pediatric residents graduating from 2011 to 2022. We used chi-square linear association to examine trends in reported race and ethnicity and multivariable logistic regression to estimate associations of race and ethnicity with graduates' characteristics including debt, career choice, job search experience, and satisfaction with specialty choice and report predicted percentage values (PV)., Results: Adjusted response rate was 53.7% (6392/11,900); 59.7% of respondents identified as white, 20.6% Asian, 10.5% Hispanic/Latino/Spanish, 5.6% Black/African American, and 3.6% Other. These percentages were unchanged across years. Black graduates were more likely than white graduates to identify as female (PV = 81.7 [95% CI = 77.7-85.8] and 73.4 [95% CI = 72.0-74.9], P < .00) and report educational debt >$200,000 (PV = 63.1 [95% CI = 57.2-68.9] and 51.2 [95% CI = 49.3-53.0], P < .00). Black and Hispanic graduates were least likely to be entering subspecialty fellowships. Black, Asian, and Other graduates were more likely than white residents to report job search difficulty. Among residents starting full-time general pediatrics positions, half or more of all race and ethnicity groups reported starting salaries of >$175,000 without significant differences. Nearly all would choose pediatrics again., Conclusions: Few strides have been made over the past decade in diversifying pediatrics. Trainees from minoritized racial and ethnic backgrounds may require support via educational debt relief, mentoring, and social support to overcome barriers and ensure their success., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors have received support from the following for the production of this manuscript, American Academy of Pediatrics., (Copyright © 2023 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of Competing Interest The authors have no example conflicts of interest to disclose.

Cross-sector partnerships are essential to ensure a safe and effective system of care for children, their caregivers, and communities. A "system of care" should have a well-defined population, vision, and measures shared by health care and community stakeholders, and an efficient modality for tracking progress toward better, more equitable outcomes. Effective partnerships could be clinically integrated, built atop coordinated awareness and assistance, and community-connected opportunities for networked learning. As opportunities for partnership continue to be uncovered, it will be vital to broadly assess their impact, using clinical and nonclinical metrics., (Copyright © 2023 Elsevier Inc. All rights reserved.)