A grant proposal from the Department of Pediatrics recently received a President’s Diversity, Equity and Inclusion Grant – one of 10 awarded across the four-campus CU system. The project, NICU Health Equity Rounds, is led by neonatal-perinatal fellow Paula Dias Maia, MD, and pediatric resident and incoming neonatology fellow Mariana Niño de Guzman, MD, with mentorship by Sunah Susan Hwang, MD, PhD, MPH, associate professor of pediatrics and Lula O. Lubchenco Chair in Neonatal-Perinatal Medicine in the Section of Neonatology and Jeanne Zenge, MD, associate professor of clinical practice and Neonatology Fellowship Program Director, Department of Pediatrics.
Designed to fund innovative and creative projects that promote diversity, equity and inclusion throughout the University of Colorado, President’s Diversity, Equity and Inclusion Grants receive up to $8,000 for one year of funding. If positive impact, potential for replication across the system, and institutionalization at the home campus are demonstrated, a second year of funding may be awarded. Here is a brief description of the awarded proposal, NICU Health Equity Rounds:
Regionally and nationally, persistent inequities exist in health care processes and outcomes among high-risk infants and their caregivers. Black infants experience disproportionately high rates of preterm birth, infant mortality and complications of prematurity compared to their white counterparts. In addition, Spanish-speaking families receive lower quality and frequency of communication from medical providers during hospitalization in the neonatal intensive care unit (NICU) compared to English-speaking families. While numerous opportunities to address and reduce these disparities exist at individual-, hospital- and community-levels, NICU Health Equity Rounds (HER) will focus on individual- and unit-level barriers and facilitators to provide equitable neonatal care. The CU School of Medicine Section of Neonatology proposes NICU HER as a strategy to engage and educate an interdisciplinary clinical audience to:
- Recognize and understand how implicit bias and social determinants of health impact patient care;
- Examine our own biases as individuals and within the health system; and
- Empower participants to create change within their professional and personal communities.
NICU HER will demonstrate positive impact, as measured by greater knowledge, intention of behavior and/or clinical practice change, and concrete unit-level improvements in care processes that improves the experiences and outcomes of our minoritized infants and families. These early stages will then inform NICU HER integration into broader perinatal DEI efforts to ensure sustainability.
This, however, is not the only DEI work being done in the Department of Pediatrics Section of Neonatology. Read on to learn more about much-needed efforts underway to improve equity and inclusion for newborns and their families.
Additional DEI-related efforts in the Section of Neonatology:
Assistant Professor Nicolle Dyess, MD, MEd, in collaboration with the National Neonatology Curriculum Committee is working on developing a national implicit bias and health disparities flipped classroom curriculum for neonatology providers. Her group has published a scoping review of implicit bias training in health professions education, a Delphi study on developing an implicit bias and health disparities curriculum in neonatal medicine, and a national needs assessment of fellows and faculty on this topic. Curriculum development is currently underway.
Additionally, Dyess has developed and led the virtual DEI 2nd look program for the Department of Pediatrics’ fellowship applicants for the past three years. During its inception year (2021–22), 14 applicants RSVPed, five of whom matched to one of the department's fellowship programs. During the 2023–24 academic year, 53 pediatric fellowship applicants RSVP’ed for the program, 12 of whom matched at the University of Colorado. She also co-developed a DEI and health disparities aim for the pediatric fellowship programs to adopt.
Assistant Professor Christina Fisher, MD, is dedicated to bridging communication gaps across diverse racial, ethnic and linguistic backgrounds. She led a Quality Improvement project aimed at enhancing the documentation of provider-caregiver communication. The initiative unearthed disparities, revealing that our non-English-preferring families were not receiving updates as frequently as their English-preferring counterparts. Complementing this effort, she led a project conducting qualitative interviews with both English- and Spanish-speaking caregivers, delving into their communication preferences and uncovering disparities based on primary language. Building on these findings, Fisher is now leading an initiative to standardize the role of interpreters within the NICU. This project aims to mitigate communication disparities experienced by Spanish-speaking families, ensuring equitable access to vital information and support.
Sunah Susan Hwang, MD, PhD, MPH, serves as principal investigator for several research and quality improvement initiatives focused on reducing disparities among high-risk infants. She is co-principal investigator for the NIH R01 funded “SAFE PreP” – Study of Attitudes and Factors Effecting PREterm infant care Practices and also principal investigator for the study entitled “Prevalence and Predictors of Sudden Unexpected Infant Death among Preterm Infants”, funded by the American SIDS Institute. Hwang formed and continues to lead two statewide quality improvement collaboratives; CHOSEN QIC (Colorado Hospitals Substance Exposed Newborn Quality Improvement Collaborative) seeks to improve care for infants and families affected by prenatal substance use; DEFINE Colorado (Data-driven Engagement of Families to Improve the NICU Experience) centers the experiences of diverse families during prolonged NICU hospitalization to improve family engagement and reduce disparities by race/ethnicity, primary language and rural/urban residence.
Current neonatology fellow and incoming faculty instructor Aniekan Udoko, MD, is passionate about the elimination of racial/ethnic and socioeconomic disparities in neonatal-perinatal outcomes through health services research. Her primary research has focused on racial/ethnic disparities in preterm infant mortality rates, timing and cause of death after discharge from the NICU with a long-term goal of utilizing advocacy, community engagement and quality improvement initiatives to create sustainable interventions.
And Jeanne Zenge, MD, in partnership with CU Anschutz’ Office of Diversity, Equity, Inclusion & Community Engagement’s Health Equity in Action Lab (HEAL), has instituted quarterly lunch hour conference DHEI discussions for faculty and fellows of the Section of Neonatology. Participants who attended and evaluated the following four modules of the program: DEI 101; Implicit Bias; Microaggressions, Upstanding and Allyship; and Equity in Action were able to obtain the “Foundations in Equity” certificate.
Dyess, Fisher and Zenge are also all alumni of the neonatal-perinatal medicine fellowship in the Department of Pediatrics.
