Terri H. Lipman, PhD, CRNP, FAAN, Miriam Stirl Endowed Term Professor of Nutrition, Professor of Nursing of Children - Clinician Educator, is Co-Investigator on a recent NIH R01 award to Dr. Adda Grimberg at Children’s Hospital of Philadelphia, “Overcoming Disparities in Growth Evaluations.”
Growth is a fundamental aspect of childhood and adolescence. The American Academy of Pediatrics acknowledged the importance of growth as a vital sign of child health in its "Recommendations for Preventive Pediatric Health Care," stating that a child's stature and weight should be measured at every well child visit through age 21 years. The differential diagnosis of short stature is very broad, including normal variants. However, many diseases present solely with growth faltering, such that failure to recognize growth faltering can lead to delayed or missed diagnosis. Timely diagnosis of such growth-stunting diseases, including (but not limited to) occult celiac disease, growth hormone deficiency and Turner syndrome, has health repercussions not only for final height outcomes, but for morbidity and mortality as well. Our underlying hypothesis is that the gender, racial and socioeconomic disparities in the management of growth faltering lead to two problematic outcomes: the inappropriate use of rhGH for socially driven height enhancement in healthy, primarily white boys, and the potential for unnecessary delays in the diagnosis of underlying disease in girls and children of racial and socioeconomic minorities. This prospective study will draw upon an extensive, demographically heterogeneous primary care pediatrics network spanning New Jersey, Pennsylvania and Delaware to evaluate disparities in two novel areas: growth evaluations by primary care pediatricians (PCPs) and issues that affect parental likelihood to seek specialist evaluation and treatment for short stature. The study takes advantage of a powerful technological advance, the electronic health record (EHR) system, as both a research and intervention tool. EHR systems enable the collection of large population data in a more accurate and objective, yet less expensive manner. As the EHR becomes universal in this country, an electronically programmed alert and decision support tool is a relatively easy method for improving healthcare consistency, eliminating disparities in growth evaluations by PCPs, and significantly impacting child health. The patient- family component of the disparate healthcare can only be addressed once its underlying factors are delineated.