New Research on Health Care Disparities in GI Procedures and Guidance on Pediatric Endoscopy

Published by Chair of Pediatrics for Hackensack Meridian School of Medicine and K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center

Harpreet Pall, M.D., MBA, CPE, chair and professor of Pediatrics at Hackensack Meridian School of Medicine and K. Hovnanian Children’s Hospital, has published new research about the social and economic influences of emergency versus non-emergency gastrointestinal (GI) procedures in children.

The paper, titled “The Role of Health Disparities and Socioeconomic Status in Emergent Gastrointestinal Procedures,” appears in the peer-reviewed medical journal, Health Equity. The paper examines how socioeconomic status influenced whether children received endoscopies in an emergent inpatient setting or in the outpatient setting as an elective scheduled procedure.

An endoscopy is a nonsurgical procedure that involves visually examining the digestive tract using a thin tube with a camera. It is a common pediatric GI procedure.

Dr. Pall and his co-authors took a sampling of more than 2,500 pediatric patients and separated them into two groups: those who had emergent procedures and those who had non-emergent procedures. The researchers then analyzed whether a variety of factors, including age, sex, race, language, zip code and type of insurance affected whether a child had an emergent versus nonemergent GI procedure.

“This study is believed to be the first of its kind to use geocoding to look at the addresses where patients live to establish patterns in emergent GI care for children,” said Dr. Pall.

The study found that the lower a child’s socioeconomic status based on geocoding, the more likely a child was to have an emergency endoscopy. Non-English or Spanish-speaking children, children younger than 5 and older than 18, and children with Medicaid insurance, were at a higher risk of undergoing emergency GI procedures. Researchers also found that children who were African American and lived in zip codes with economic challenges had a higher rate of emergent GI procedures.

“This research has helped us understand what factors lead children to seek GI care in the emergency department and how socioeconomic factors, place of residence, and type of insurance may play a role,” said Judy Aschner, M.D., physician-in-chief for Pediatrics at Hackensack Meridian Children’s Health.

“Dr. Pall has used innovative research methods and given us an opportunity to further analyze how our patients receive care,” said Vito Buccellato, president and chief hospital executive of Jersey Shore University Medical Center. “As a result, we can focus our efforts on improving outreach and access to pediatric GI care for patients at higher risk of having an emergency procedure.”

In addition to the study, Dr. Pall published guidance in the third edition of the textbook “Practical Pediatric Gastrointestinal Endoscopy.” The textbook is the gold-standard reference for pediatric endoscopy standards of care and practice. It is geared toward all medical professionals practicing diagnostic pediatric endoscopy, including gastroenterology fellows and anesthesiologists. Dr. Pall’s contribution addresses best practices for setting up pediatric endoscopy units.

About Dr. Harpreet Pall

Dr. Pall is chair and professor of the Department of Pediatrics at Hackensack Meridian School of Medicine and K. Hovnanian Children's Hospital at Jersey Shore University Medical Center. He completed his medical degree from McGill University and pediatrics residency from Memorial University in Canada. He then completed a fellowship in gastroenterology from Harvard Medical School/Boston Children's Hospital. After completing his fellowship, Dr. Pall joined the faculty at Boston Children's for six years where he led endoscopy services at ASCs and assisted in EHR implementation. In 2011, Dr. Pall was recruited to St. Christopher's Hospital for Children/Drexel University College of Medicine as Chief of Gastroenterology where he served in numerous leadership roles including Executive Vice-Chair, President-Elect of the Medical Staff, and Pediatrician-in-Chief/Chair prior to assuming his current role at Hackensack Meridian Health.

Dr. Pall has formal management and leadership training including an MBA from University of Massachusetts, year-long leadership fellowship, medical management coursework at Harvard, a Dean's internship at Drexel, and the Certified Physician Executive (CPE) designation. He serves on the Advisory Board of the Transformative Leadership in Disruptive Times certificate program at Seton Hall University Stillman School of Business.

Dr. Pall has been nationally recognized for his scholarship in health equity, social determinants of health, clinical efficiency, and patient experience as related to the field of pediatric endoscopy. During the COVID-19 pandemic, he served as chair of the Hackensack Meridian Support our Schools COVID Advisory Board. This program helped support more than 138 New Jersey schools as they navigated the pandemic. Dr. Pall is also the chair of the Finance and Operations Committee of the Hackensack Meridian Health Medical Group. Finally, he enjoys his active clinical practice as a board-certified pediatric gastroenterologist.