Health Equity & Inclusion

Every child and every family is different. Each has their own specific needs, opinions, beliefs, religions, and cultural backgrounds — all of which can impact how they view and would like to receive health care. That’s why we created the Office of Health Equity and Inclusion (OHEI) to help us be respectful, sensitive, and mindful of the cultural and spiritual needs and differences of the children and families we see every day.

We’re here to learn, listen, and help inform every member of our staff about what we
can all do to treat you and your child with the care and respect you deserve — tailored
to you.

Our Firm Commitment to Equal Care

Our Office of Health Equity and Inclusion seeks to partner with you, the families. We want you to let us know how you’d prefer to be treated — and how we could improve our care to best help your family through every age and stage. We want to hear about your cultural background, beliefs, and language needs to help us give you the very best care we can.

Our Language & Interpreter Services

To make sure you understand everything about your child’s care (from diagnoses to treatments to discharge instructions), we offer interpreter services for children and families who don’t speak English in these locations.

Why This Is Important to Us

To fulfill our promise to care for every child as we would our own, we know we need a deep respect of different cultures, languages, genders, religions, socioeconomic statuses, and more. Only then can we truly understand the needs of the children we see. And only then will children and their families truly understand the care they’re receiving — and what they need to do after they leave our hospital to help ensure children’s health and well-being.

The Office of Health Equity and Inclusion will help us all become more aware by partnering with our patients and communities — and collecting and providing needed input from families like yours.

Research shows that patients and families of different cultural backgrounds and languages are not only often treated differently (and less effectively) while they’re at our nation’s hospitals, they also often don’t understand their diagnoses, care plans, and discharge instructions as well as they could if they were given the proper care and attention to their specific needs.

This creates situations where patients’ conditions have been compromised — they don’t get better, they get worse, and/or they often end up right back at the same hospitals, simply because they didn’t have the information and guidance they needed to completely understand how to manage their conditions.

If we are to give consistently equal health care and get consistently equal outcomes (results) for everyone, health care systems nationwide need to do
a better job of understanding and communicating with all of our patients and
their families.

Nemours Health Disparities Science Research (NHDSR) integrates the traditional health disparities indicators (namely race/ethnicity, sex, age and disability) with emerging indicators (particularly obesity/overweight and substance abuse/dependence) in examining variability in health outcomes across diverse populations, and mapping intervention in order to narrow these variances. By utilizing traditional and molecular epidemiologic tools, the overarching purpose of this initiative is to narrow health disparities in incidence, prevalence, severity and progression as well as mortality.

With the biological and molecular aspects of health disparities etiopathogenesis, the NHDSR emerges as a leader in health disparities science research by being one of the few institutions to assess biomarkers as predispositions to racial/ethnic disparities in incidence, prevalence, severity and mortality outcomes. Studies conducted by our division are used to inform clinicians and other health care providers regarding determinants of differences in health and health care outcomes, and how to remove such factors in order to achieve equitable care and comparable outcomes across diverse patient populations.

At Nemours, health disparities science research originates primarily from the Nemours Office of Health Equity and Inclusion (OHEI). The research activities involve quality, workforce diversity, community engagement, cultural/linguistic competencies and specific health/health care outcomes. In assessing health care processes and outcomes as related to health disparities indicators, NHDSR collaborates with several departments and divisions across Nemours, including Nemours Health & Prevention Services (NHPS), musculoskeletal/orthopedics, hematology/oncology, trauma and the Emergency Department (ED).

Current Projects

 
Serum Lipid and Racial/Ethnic Variances in Childhood Higher Body Mass Index (BMI)

Childhood obesity remains an epidemic. With obesity related to several chronic diseases (including asthma, heart/vascular diseases and renal issues), understanding factors predisposing to obesity is important. Also key is examining several subpopulations to determine what tends to contribute to higher prevalence in one racial/ethnic group in relation to another. In our patient sample, overweight/obesity is most prevalent among African-American and Hispanic children, is intermediate among Caucasian/white children, and is lowest among Asians. Our ongoing study on serum level as a biomarker of obesity demonstrated racial/ethnic variance in the characterization/stratification of this biomarker. Our ongoing project is to identify other potential biomarkers of obesity and stratify them by race/ethnicity (as well as sex) in an attempt to understand how some subpopulations may be predisposed to overweight/obesity. Such an initiative will provide the opportunity for race/ethnic and sex-specific intervention mapping to reduce the overweight/obesity epidemic, thus narrowing health disparities therein.

 
Racial/Ethnic Disparities in In-Hospital and Out-of-Hospital Pediatric Mortality

Pediatric mortality tends to vary across subpopulations with African-Americans and other races in our sample bearing the greatest burden in this outcome. Whereas national data on pediatric mortality consistently illustrate similar observations as those obtained from our data, in-hospital mortality tends to be lower in our sample relative to comparable settings in pediatric institutions across the United States. This project annually examines the in-hospital mortality experience, as well as the racial/ethnic disparities therein. Interestingly, our project attempts to explain racial/ethnic disparities in the mortality outcome by controlling for factors known to predispose mortality (such as severity of illness, medical insurance, socioeconomic status proxy, etc.).

 
Health Disparities in Pediatric Asthma: Prevalence-Proportionate Morbidity, Admission/Readmission, ED Visit, Asthma Action Plan, Medication Adherence, Comorbidities & Mortality

Childhood asthma remains the leading cause of chronic disease and disability among children in the United States. The prevalence of disease severity, health care utilization and mortality vary across subpopulations. Understanding this determinant remains essential in the process of managing these children, with the intent to optimize outcomes across diverse populations. With this repeated cross-sectional assessment, this project examines proportionate morbidity in asthma by race/ethnicity by assessing the number of patients readmitted with asthma within 30 days and 7 days after discharge from the hospital. Also assessed is how asthma severity varies by sex, race, ethnicity and body mass index (BMI). The racial/ethnic variability in mortality remains an important focus of this project, as well as factors that may explain the observed differences.

 
Health Disparities in Pediatric Overweight/Obesity

The health status of a nation can be predicted by using pediatric health status. The current obesity epidemic is the classic indicator of adult chronic disease and disabilities prevalence. This project examines, with repeated cross-sectional data, several health disparities indicators in an attempt to offer explanation about racial/ethnic disparities in childhood overweight and obesity. Besides looking at traditional predisposing factors, we consider social media resources available to racial/ethnic minorities in maintaining normal body weight.

 
Culturally Competent Care: Assessment of Impact Cultural Competence Training in Improving Health Equity

Cultural competence training and education (CCTE) has been shown to improve care in some settings. This project assesses the knowledge, perception and skills of our Associates (Nemours employees) in providing care to our patients, with respect to what is considered culturally competent care. The research involves examination of knowledge, perception and skills indicators before and after CCTE in order to determine whether or not this intervention enables our Associates to provide standardized care that is comparable across a diverse patient population. We have developed and are working on releasing a conceptual framework of culturally competent care for pediatric asthma. This framework focuses on how culturally competent care training about asthma for providers, patients/families and health care systems can increase knowledge, attitude and skills development in providers, lead to increased patient engagement and trust, and support and encourage culturally diverse asthma treatment and prevention protocols by the health care system. The ultimate impact of CCTE is to narrow health disparities in the outcomes of care.

 
Health Disparities in Pediatric Malignancies: Incidence Progression in Survival, Risk/Predisposing Factors

Racial/ethnic variances exist in childhood asthma incidence as well as mortality. In some cases, like leukemia, while incidence is highest among Caucasian/white children, mortality remains highest among African-American children. This project examines repeated cross-sectional as well as longitudinal data for evidence of health disparities in incidence, prognosis and mortality outcomes. Emphasis is placed on malignancies that were previously rare among children, and those that are known to be rare among racial/ethnic minorities such as testicular neoplasm. Currently, this project examines leukemia, thyroid, brain and central nervous system tumors — prevalence and survival — stratified by race/ethnicity, age at diagnosis and sex.

 
Biomarker Characterization and Stratification by Sex, Race, Ethnicity in Chronic Disease and Cancer

Biological markers of disease have been historically used to ascertain clinical disease status. The use of biological markers enables practitioners to obtain early diagnosis, thus increasing the outcome of the prognosis upon treatment. Since disease incidence, prognosis, severity and mortality continue to vary by health disparities indictors, characterizing and stratifying biomarkers by race, ethnicity and sex may provide substantial information about whether or not some subpopulations are predisposed to a certain disease condition. For example, if immunoglobulin E (IgE) (the antibody responsible for hypersensitivity reaction) concentration is higher among African-Americans, does this imply that African-American children are more predisposed to asthma? The first biomarker characterized so far is serum lipid level in childhood higher body mass index (BMI).

 
Workforce Diversity and Health Equity Implication

Studies have shown a direct correlation between improvement in outcomes of care and professional diversity. This project attempts to study outcomes of care by race/ethnicity, correlating these outcomes with the culture of the providers.

Publications

Browse a listing of publications from Nemours researchers related to health disparities science research.

 
2013
 
2012

Contact Us

The Nemours Office of Health Equity and Inclusion

252 Chapman Road
Christiana Building, Suite 200
Newark, DE 19702
(302) 444-9070
OHEI@nemours.org