PROJECT SUMMARY/ABSTRACT In the pediatric emergency department, children who belong to racial, ethnic, and language minority groups are less likely to receive interventions such as antibiotics and pain medication. Importantly, minority children are more likely to die of emergency conditions, including sepsis and cardiac arrest. Eliminating inequity requires strategic and rigorous approaches across multiple levels. Dr. Colleen Gutman is an Assistant Professor of Pediatric Emergency Medicine at the University of Florida. Her long-term goal is to become an independently funded physician-scientist with a focus on investigating and implementing strategies to promote equitable, patient-centered pediatric emergency care. Through the support of a KL2 award, Dr. Gutman gained introductory skills in multi-center health disparities research, qualitative analysis, and health communication science. To achieve a successful transition to research independence, Dr. Gutman and her multidisciplinary mentorship team devised a career development plan that builds from that foundation. With this K23 award, Dr. Gutman will develop advanced skills in 1) the identification and measurement of implicit bias, 2) the science of patient-centered communication, 3) advanced mixed methods, 4) academic leadership, and 5) scientific writing. The career development plan will be complemented by mentored research experiences. Using the NIMHD Research Framework, the proposed research seeks to define elements of the physician-parent interaction that contribute to child health disparities. The objective is to define how implicit bias affects physician behavior in the pediatric emergency department. This is a necessary first step that will inform targeted interventions aimed at reducing child health disparities. In Aim 1, Dr. Gutman will use a parent- engaged modified Delphi approach to establish physician behaviors (e.g., assumptions about parent characteristics and access to resources; communication with parents) that may mediate the relationship between physician implicit bias and child health disparities. In Aim 2, she will collect paired questionnaires from pediatric emergency physicians and parents. She will analyze physician-parent response concordance on items evaluating parent characteristics and access to resources. Through this analysis, she will assess for systematic differences in the accuracy of physician assumptions based on parent race, ethnicity, and language. In Aim 3, she will video-record pediatric emergency department encounters to analyze the relationship between physician communication and parent race, ethnicity, and language. Physician behaviors that differ for minority parents may mediate the relationship between physician implicit bias and child health disparities. The findings will inform a multicenter R01 proposal that is fully powered to conduct a mediation analysis assessing the relative importance of the defined behaviors on patient-centered disparities outcomes. Long term, this research will inform targeted interventions to reduce disparities in child health.

PROJECT NARRATIVE Children who belong to racial, ethnic, and language minority groups are more likely to die of emergency conditions and, during emergency department visits, are less likely to receive interventions such as antibiotics and pain medication. Such differences in care and outcomes are due, at least in part, to implicit racial bias, yet educational interventions that increase physician awareness of implicit bias are not sufficient to reduce disparities in patient-centered outcomes. This proposal aims to define how implicit bias affects physician behavior in the pediatric emergency department and create a critical foundation for prioritizing behavior change in future bias-reduction intervention research.