Overcoming Demographic Disparities in Medicine (S3:E60)

Prenatally diagnosed with hydronephrosis, babies of ethnic minorities get surgery sooner than white ones, often within the first year. That's well documented. The tricky question is why. What role does implicit bias play? And at what point during the process does it come into play? What imaging studies do surgeons order, and how do they interpret the findings? How do those interpretations influence the decision of whether to do surgery, or when?

Listen to a pediatric expert discuss demographic disparities in medicine

In today’s episode, we talk with Vijaya Vemulakonda, MD, JD, about studying demographic disparity in medicine and how the electronic health record (EHR) can help close the gap. Dr. Vemulakonda is a pediatric urologist at Children’s Hospital Colorado and Associate Professor of Surgery and Urology at the University of Colorado School of Medicine.

In this episode, our experts discuss:

• How Dr. Vemulakonda became interested in the disparities in hydronephrosis treatment
• The clinical decision-making process urologists go through regarding when to operate and when to observe
• The lack of clear evidence-based guidelines on how to treat ureteropelvic junction (UPJ) obstruction
• Dr. Vemulakonda’s approach to researching the problem of demographic disparities in the treatment of hydronephrosis
• The qualitative interviews they conducted with parents of children diagnosed with high-grade kidney dilation concerning for UPJ obstruction
• The interviews they conducted with pediatric urologists across three tertiary referral centers to get a sense of what they do in practice and how they make decisions
• How implicit bias factors into the approach to treatment
• A family’s ability to follow up and how providers can engage families in an efficient and effective way
• The next phase of research: a prospective observational cohort, which includes funding three tertiary referral centers
• The next goal of the study, which is standardizing evaluation so providers can measure what the true impact of surgery versus observation is on short- and long-term kidney outcomes
• The use of the EHR in Dr. Vemulakonda’s research
• The creation of research tools that were integrated into clinical charting to track the studies providers order, how patients present and the primary reason for undergoing surgery or being observed
• Read more about Dr. Vemulakonda's research.

Hydronephrosis treatment at Children’s Colorado

Our providers in the Department of Pediatric Urology have extensive experience in medical management of hydronephrosis as well as moving forward appropriately with surgical intervention, if necessary. Our urology team is currently collecting research about hydronephrosis to ensure that current practices are the most up to date and as efficient as possible.