Operationalizing Equity: A Methodologic Framework for Revising Pediatric Clinical Guidance

Healthcare inequities and resultant disparities in health outcomes can be influenced by clinical guidelines and organization policies. This guidance may be implicitly or explicitly embedded with bias, discrimination, and racist ideologies which have the potential to cause harm, not only for historically marginalized and minoritized communities, but also at a broader population health-level. The American Academy of Pediatrics (AAP) is a professional society responsible for the creation and dissemination of many clinical practice guidelines (CPGs) and clinical reports (CRs) to promote child health. Recognizing the importance of ensuring that these CPGs and CRs promote health equity, the AAP convened a group of health services researchers to develop and pilot an evidence-informed instrument to assess for the inappropriate use of race and/or ethnicity. This article describes the methodological approach to developing and applying the evidence-informed instrument to the compendium of active AAP CPGs and CRs. We also present an approach for prioritizing CPGs and CRs most urgently in need of revision and describe a process to achieve buy-in within AAP leadership, and among the authoring groups and other partners. The process described here may be utilized by other professional societies and healthcare organizations to assess their own clinical guidelines.