TABLE IV.

Toolkit: identify and address health disparities competency domains

Area	Opportunities and mechanisms to address health disparities for trainees and providers	Resources
General concepts for health disparities focused care of patients with allergic and immunologic diseases	Educational course for trainees and providers	AAAAI Slide Deck17 on Disparities within Allergy and Immunology by the Committee on the Underserved (AAAAI membership required) Health and Human Services has created an educational program18 for physicians (and other providers) directed at addressing the National CLAS Standards, which are a set of 15 action steps intended to advance health equity, improve quality, and help eliminate health care disparities AAP Course: Fighting Racism to Advance Child Health Equity (AAP membership required)19
	Engage in structural humility by identifying bias and structural barriers in local context	Hire and support diverse staff representative of the community—American Hospital Association Diversity Assessment Tool20 Ensure that systems are in place to provide culturally competent, shared decision-making in counseling and education regarding disease—Cultural Competency Self-Assessment Tool21 by the NCCC
	Incorporate and assess community needs or social determinants of health assessments in clinical practice and management decisions	Adaptable resources	American Academy of Family Practice 10-Question Screening Tool22 (Everyone Project) iScreen Social Screening Questionnaire—46 Question Survey Tool23 CDC Community Health Improvement Navigator24 NACHC Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE)25 Rural Health Information Hub’s Tools26 to assess and measure social determinants of health
Care of patients with food allergy	Engage in structural humility by identifying bias and structural barriers to care/health outcomes	Educational course for trainees and providers	Recorded episode of the AAAAI podcast series, Conversations from the World of Allergy—Carla Davis, MD, FAAAAI, discusses disparities related to food allergy27
		Administrative interventions	Best practice checks to ensure that Food Allergy Plans, EAI, and Food Insecurity screenings are provided/performed for all patients
	Create multidisciplinary approaches to address complex care needs (eg, social work, dietician, nutrition, pharmacists, etc)	Examples of programs	Children’s Mercy Food Allergy Center of Excellence28 Industry Sponsored EpiPen for Schools Program29
	Design peer-based educational sessions with partnered referral providers and communities	Examples of programs	Code Ana30—Guides schools through the development and implementation of medical emergency response plan
	Identify and partner with local and national advocacy groups	National advocacy and patient-centered groups	Food Allergy Research and Education31 The FPIES Foundation32 Food Equality Initiative33
Care of patients with atopic dermatitis	Engage in structural humility by identifying bias and structural barriers to care/health outcomes	Educational course for trainees and providers	Dermatologist, Amy McMichael, MD, Chair of the LiVDerm Deep Dive Racial Disparities in Dermatology programs, shares highlights in a youtube video34 on the current health disparities in dermatologic care for patients with skin of color The Impact of Skin Color and Ethnicity on Clinical Diagnosis and Research, Virtual Series35 by Skin of Color Society, NEJM Group, and VisualDx
	Identify and partner with local and national advocacy groups	National Eczema Association36 International Eczema Council37 National Eczema Society38 Skin of Color Society39
	Identify alternative resources to train providers in recognizing AD in patients of all skin types	ACAAI and AAN partnered teaching resource Project impact40
Care of patients with asthma	Engage in structural humility by identifying bias and structural barriers to care/health outcomes	Educational course for trainees and providers	Recorded episode of the AAAAI podcast series41, Conversations from the World of Allergy featuring interview with Tamara Perry, MD, FAAAAI, on socioeconomic and racial/ethnic disparities of asthma
		Administrative interventions	Best practices check to ensure that appropriate clinical assessments and medication use are evaluated during visits Increase funding to provide care to underinsured and publicly insured patients Assess opportunities to implement prescription monitoring programs to assess costs and adherence in addition to best prescribing practices are used during care visits
	Incorporate social determinants of health assessments in community clinics or multidisciplinary academic clinics	Example program	Impact DC Program42 sponsored by Children’s National Medical Center
	Identify and partner with local and national advocacy groups	National and patient advocacy groups	Asthma and Allergy Foundation of America43 Allergy and Asthma Network44
		School-based programs	AAAAI - School-based Asthma Management Program45
	Understand and incorporate the impact environment on health outcome	Environmental Protection Agency (EPA)—EJScreen	An environmental justice mapping and screening tool called EJScreen46 Combines environmental and demographic indicators in maps and reports
Racism, bias, or discrimination in recruiting practices and protocol design for research studies	Engage in structural humility by incorporating bias and disparities training related to research into fellowship curricula	AAAAI educational lectures47
		QI projects	Encourage the assessment and implementation of DEI-focused quality improvement projects and efforts for the clinical practice, institutional policies, and research protocols at the practicing institution
		COLA Conference Lecture by Dr Bridgette Jones	Dr Jones’ COLA lecture48 on bias and racism (presented on August 14, 2020)
	Assess understanding of the impact of structural racism on health outcomes and research design	Integrating equity into QI and PS (Institute for Health Care Improvement-IHI)	Free IHI resources49 available to help guide and support health care entities and providers interested in developing sustainable ways to advance health outcomes within their community, health system, and beyond
		PROMIS (Patient-Reported Outcomes Measurement Information System)	A set of person-centered measures50 that evaluates and monitors physical, mental, and social health in adults and children. It can be used with the general population and with individuals living with chronic conditions
		Agency for Healthcare Research and Quality	A comprehensive source of data on health care delivery and patient outcomes over time, and at the national, regional, state, and community levels. In addition, the National Healthcare Quality and Disparities Report presents trends for measures related to access to care, affordable care, care coordination, effective treatment, healthy living, patient safety, and person-centered care Healthcare Cost and Utilization Database51 National Healthcare Quality and Disparities Reports52
		AAAAI Committee on the Underserved	Committee focused on defining, addressing, and mitigating health disparities within allergy/immunology in racial and ethnic underserved populations9
	Engage with private and public entities with vested interest in identifying, prioritizing, and addressing disparities in clinical practice and research involving patients from minoritized backgrounds	Patient-Centered Outcomes Research Institute (PCORI)	PCORI53 funds research that offers patients and caregivers the information they need to make important health care decisions. The Evaluation and Analysis program provides evaluation expertise, whereas the Engagement program gives patients, caregivers, clinicians, and other health care stakeholders opportunities for meaningful involvement in all their activities
		National Institute of Minority Health Disparities (NIMHD)—HD Pulse	A repository of data54 and resources for addressing health disparities including a data portal for analyzing health disparities and intervention portal (still in development) for identifying evidence-based interventions for addressing health disparities
		NIMHD Publication (Textbook)—The Science of Health Disparities Research	A textbook55 authored by experts in health disparities research that provides information on conducting clinical and translational health disparities studies
		NIMHD—Health Disparities Research Institute	The National Institute on Minority Health and Health Disparities (NIMHD) annually hosts the Health Disparities Research Institute (HDRI)56, which aims to support the research career development of promising early-career minority health/health disparities research scientists and stimulate research in the disciplines supported by health disparities science
		The Office of Minority Health of the HHS	The Office57 provides quantitative information related to health, including sourcing and maintaining a body of expert knowledge on health status initiatives, and demographic statistics and analyses on disadvantaged populations, compiled by the National Center for Health Statistics, the Census Bureau, private foundations, clinical practitioners, private data sources, and public agencies
		CDC CORE Health Equity Science and Intervention Strategy	CDC’s CORE Health Equity58 Science and Intervention Strategy is designed to work in collaboration to challenge CDC centers to incorporate health equity and efforts to address health disparities as a foundational element across all our work—from science and research to programs, and from partnerships to workforce
		National Minority Quality Forum	The NMQF59 is a research and educational organization dedicated to ensuring that high-risk racial and ethnic populations and communities receive optimal health care
		PRIDE—RISE Program	UCSF Research in Implementation Science for Equity (RISE)60 Program are to train and sustain scholars underrepresented in biomedical sciences for long-term success in academic careers pursuing innovative research of interest to the NHLBI
		HOPE Initiative	Interactive data tool61 designed to track social determinants of health and health outcomes by race, ethnicity, and socioeconomic status on state and national level
		PhenX Toolkit	Catalog of validated resources62 for measurement of social and structural impacts on health for incorporation in research
	Improve gaps and disparities in recruitment practices and protocol design	MRCT Center of Diversity, Inclusion, and Equity in Clinical Research	A collaborative resource created by a diversity representative workgroup; their website63 features resources, tools, case studies, and documents designed to help improve diversity in clinical research