The American Academy of Pediatrics consistently excels in crafting guidance and policy statements tailored to specific populations. Dedicated and experienced members invest substantial time and resources in these frequently updated statements. While they are often lengthy, it is our hope that they are thoroughly reviewed by the membership and those shaping policy.
In recent weeks, I have highlighted disparities within various underserved populations, including Black, Hispanic, Foster Care, and Appalachian children. Links to pertinent AAP statements are provided below. The AAP has issued statements for most of these areas, though I was unable to locate specific statements for Appalachia or Black children. However, I did find the following statements that offer recommendations for improving care. If you are inclined, you can delve into each statement to gain in-depth knowledge on these subjects, along with key recommendations. If I have overlooked any statements related to underserved Black or White children, please do inform me.
These statements, though comprehensive and extensive, share common themes. Therefore, I asked ChatGPT to distill the recurring recommendations and pinpoint areas where we can focus to enhance care. Here's ChatGPT's analysis:
- Cultural Competency: Emphasizing the importance of cultural competence and sensitivity among healthcare providers, urging recognition of inherent biases and improvements in cultural humility and effective communication.
- Access to Care: Highlighting the necessity for comprehensive, coordinated, culturally effective care, and the establishment of medical homes with designated primary care providers.
- Mental Health: Advocating for integrated mental health services and trauma-informed care to reduce access barriers, particularly for populations with distinct mental health needs.
- Language Services: Recommending the use of trained medical interpreters to facilitate communication, discouraging reliance on family members, friends, or children as interpreters. Emphasizing translation of materials into patients' preferred languages when feasible.
- Social Determinants: Stressing the significance of screening for social determinants of health, assessing development and behavior, and addressing social and economic factors affecting health.
- Trauma-Informed Care: Encouraging a trauma-informed care approach with attention to multigenerational trauma and mental health support.
- Childhood Development: Promoting the assessment of development, learning, and behavior for all children, regardless of their background, while considering dual language as an asset.
- Community Engagement: Emphasizing collaboration with communities and local resources, including partnerships with tribes and advocacy for culturally sensitive care practices.
- Target Populations: The texts address different populations, with one focusing on immigrant families and another on American Indian and Alaska Native (AI/AN) communities.
- Specific Recommendations: The second text provides more specific recommendations tailored to AI/AN communities, such as addressing prediabetes, promoting breastfeeding, and offering gender-affirming care.
- Racial and Cultural Considerations: The second text addresses the impact of racism and underscores the importance of recognizing and addressing racism within clinical settings, a topic not as explicitly discussed in the first text.
- Child Welfare and Adoption: The third text discusses children and adolescents involved in the child welfare system, including those in foster care and adoptive families, emphasizing the need for interdisciplinary care and support.
- Transitioning Youth: The third text explores the challenges faced by young adults transitioning out of care and those involved in the juvenile justice system, highlighting their risks and the necessity for advocacy and support.
- Language Usage: The third text encourages using positive language when discussing adoption and foster care with children and adolescents.
These texts offer valuable guidance to healthcare providers and, despite their differences, share a commitment to tailoring recommendations to the unique needs and challenges of the populations they serve.
I often contemplate why we struggle to identify the common threads within the numerous whitepapers, guidelines, and policies that are written. Why do we not recognize the essential needs and shape our interventions around these straightforward requirements? While AI may not be the sole solution to these problems, can it assist us in comprehending what we may be overlooking? I frequently challenge those who believe that artificial intelligence can fix healthcare—it simply can't without a shift in human action and a reevaluation of its role.
It seems to me that we may be neglecting our ability to address the fundamental aspects of improved healthcare for all. In our pursuit of gadgets, gizmos, workarounds, and fragmented care driven by consumerism, we may be missing the mark. Even our actions may be misdirected.
So, if we genuinely desire to rectify healthcare disparities, it must commence with the basics—acting upon what the actual needs are and identifying areas where we can genuinely effect change, instead of merely discussing disparities.
- Culture: We require diversity across our healthcare system, spanning from training to delivery and outlining outcomes. Understanding both our cultural differences and commonalities would significantly inform the design of our interventions. Silos and homogenous thinking do not serve the purpose of learning what everyone requires or desires.
- Primary Care: Authentic, locally trusted primary care, centered on comprehending patients' needs and addressing them, recurs as a prevalent theme. The concept of the medical home is crucial, as are enduring relationships with consistent primary care providers. The data in support of this is compelling.
- Mental Health: Halting the segregation of mental health and physical health is an unequivocal step. Why do we not integrate mental health care into the medical home?
- Language: Once again, this is an area overlooked by our payment system. Primary care often cannot surmount this basic barrier due to financial constraints.
- Social Determinants: Who understands the social barriers or challenges better than someone who meets the criteria in points 1 to 4? Who is better positioned to address these than the aforementioned individuals?
- Trauma-Informed Care: Yes, who can more aptly identify and effectively treat trauma-induced issues than someone with whom a patient shares trust and a longstanding relationship?
- Childhood Development: Is there an app for that? Or does it necessitate a continuous, long-term relationship to monitor progress over time, to identify issues early on, rather than waiting until a child enters school?
- Community Engagement: Once again, the need for healthcare to actively involve and engage the local community emerges. This community understands points 1-5 and can offer the support required for prevention and intervention.
Ultimately, consider the distinctions and explain to me how the foundation outlined above cannot locally mitigate the disparities witnessed among diverse cultures or patient populations.
The interpretation of artificial intelligence, akin to human intelligence, underscores the necessity for foundational aspects to enhance care for all children. So, why do we invest so significantly in hospitals, tertiary care, technological workarounds, and fragmented, consumer-driven care? I find myself perplexed. Please assist me in comprehending this.
Indeed, every child is unique, and their individual characteristics and needs can never be fully addressed by artificial intelligence. However, AI can play a crucial role in helping us recognize how we've strayed from the solid foundation of healthcare, which is now showing signs of wear and tear. Healthcare disparities are expanding, and the quality of care is diminishing. So, how can we change our approach?
AI is highly touted for these possible use cases:
- Identify Disparities: AI can analyze vast datasets and identify healthcare disparities that may not be immediately apparent. It can pinpoint areas where certain populations are underserved or facing unique challenges.
- Inform Policy: By providing data-driven insights, AI can inform policymakers about the root causes of healthcare disparities. This information can lead to more targeted and effective policy changes.
- Enhance Efficiency: AI can streamline administrative tasks, reducing the administrative burden on healthcare providers but it must also ensure that we are improving outcomes.
- Support Clinical Decision-Making: AI-powered clinical decision support systems can help healthcare professionals make more accurate diagnoses and treatment recommendations, ensuring that each child receives personalized care.
- Patient Engagement: AI-driven tools can engage patients in their healthcare journey, providing them with tailored information and reminders, ultimately improving health outcomes.
- Resource Allocation: AI can assist in allocating healthcare resources more efficiently, ensuring that underserved populations receive the attention they need.
Artificial intelligence, however, cannot take action, nor can it guarantee that we are providing it with unbiased data or interpreting its results without our own biases. To effect change and address the widening disparities and declining care quality, WE must:
- Rebuild the Foundation: Acknowledge the importance of primary care, mental health integration, cultural competence, and addressing social determinants of health. These are the building blocks of a robust healthcare system.
- Collaborate: Healthcare should not exist in isolation. Collaborate with local communities, engage patients, and involve diverse voices in decision-making.
- Prioritize Prevention: Focus on preventive care to catch health issues early and reduce the burden on the healthcare system.
- Invest in Education: Train healthcare professionals to understand and respect cultural differences and the impact of social determinants on health.
- Use Technology Wisely: Embrace AI and other technologies as tools to support healthcare, not as substitutes for human care and compassion.
- Advocate for Change: Be an advocate for policies and practices that address healthcare disparities and prioritize the well-being of all children.
While AI cannot replace the human touch in healthcare, it can certainly help us refocus on the fundamentals and act differently to build a more equitable and effective healthcare system for every child. The fact is, though, we MUST ACT DIFFERENTLY.
Other articles from this series of our inequitable care system...
Note: As a reminder this newsletter is written from my experience and perspective. The newsletter does not imply or relay the opinions of others. The intent is to offer an avenue for dialogue and discussion around important topics in healthcare and healthcare innovation from one doctor’s perspective. I am a physician and so can only write from my perspective. If you are clinician, provider, nurse or whatever my goal is to enable you to agree or disagree. I have no intention to suggest or imply that only the physician perspectives matter. They do matter but as part of a larger dialogue that can foster better health outcomes. Edited with ChatGPT.
Founder @ Sirica Therapeutics | Building Innovative Autism Therapy
1yTotally agree, J. Michael Connors MD !
3D Healthcare 💙 Kind Workflow Improvement that Heals Staff of Burnout at its Source ♦ Improved Patient Experience ♦ Improved Profitability ♦ 3D Train-the-Trainer Certification Program ♦ A Loving Organization Consortium
1yJ. Michael Connors MD - Is AI going to benefit healthcare? Yes, in profound ways. Is AI going to destroy healthcare? Probably, in profound ways. The question is who benefits? and who gets hurt? The benefits are going to accrue mostly to those at the top in the form of lower costs and higher profits. The losses will accrue where they always do, with the little people--staff, patients and the masses. As always Mick, follow the money. Will the money suddenly be in primary care, or rural care or under-served communities or in the wellbeing of staff or patients? Highly doubtful. As long as AI is about making money and cutting costs, it will make things worse for almost everyone except those at the top. I'd like to be wrong on this. 💙
Advisor Ai & Healthcare for Singapore Government| AI in healthcare | TedX Speaker #DrGPT
1yI appreciate you J. Michael Connors MD, and am glad you challenge AI and Healthcare. I know your intent is focused on the patient. ( If even if I have to take more blood pressure medications because of you, I am fine with it, lol). I am focusing on the patient and helping healthcare. In a month, I will announce several healthcare solutions that I believe will make a true difference.
Co-Founder ViTel Health *Champion for Independent Physician Practices and Equitable Care * Healthspan Optimization Physician with Rebel Health Alliance
1yYes healthcare that is fragmented, profit-driven, isolating, and wasteful is worst of all ineffective and abusive. WE need to utilize the tools of digital health to create a medical system that is connected, collaborative, compassionate, and humane.
Author, Value Creation Advocate
1yThanks for this, J. Michael Connors MD. I agree wholeheartedly with the eight points you identify as areas where we can genuinely effect change. Non-AI humans have been saying the same for years. To your point, let's quit talking and get to doing. You mention AIs ability to identify disparities. Unfortunately, this is currently limited by our ability and willingness (both medical professional and patient) to document potential social risks in discrete data fields to fully inform AI's analysis of those data sets. Zip code level of differentiation can inform a macro-approach to which programs and supports are likely most needed in an area, but it will not solve the individual's problem. I hope a solution to this issue will soon emerge.