Case Studies
Case Study: Going Bigger: How the American Academy of Pediatrics Built a Comprehensive Framework for Equity-Conscious Decision-Making

March 2026

The Challenge

After discovering that bias was broadly embedded across their library of clinical guidance documents, the American Academy of Pediatrics faced a daunting question: How do you systematically reimagine an entire ecosystem of clinical guidance that influences 67,000 pediatricians nationwide?

The Approach

Rather than addressing each guideline individually, the AAP adopted a comprehensive framework for equity-conscious decision-making beginning with an ambitious systematic review with the goal of identifying the most relevant existing framework for incorporating equity into guideline development.

The Unexpected Discovery

The research yielded a surprising insight: addressing equity in guidelines requires more than fixing the guidelines themselves. Many of the considered frameworks extended beyond guideline development to encompass areas such as primary research, implementation strategies, and clinical education. These results transformed the AAP approach from creating a single framework to developing a comprehensive program for equity-conscious decision-making.

The Innovation

The resulting AAP framework addresses equity at every decision point. During guideline development, this includes topic prioritization that considers health equity; panel appointment that ensures diverse representation; and recommendation language that avoids stigmatization. Beyond the guideline development process, this includes research protocols that include diverse populations; communicating with patients about algorithm-based decisions; and engaging in medical education to ensure clinicians understand the health impacts of racism.

The Practical Tools

 Recognizing that frameworks without implementation guidance often fail, the team developed concrete “dos and don’ts”: 

DO

  • Consider whether including race/ethnicity may exacerbate inequities 
  • Include implementation guidance for disadvantaged populations 
  • Train research staff in cultural humility 

DON’T

  • Use race as a surrogate for social variables 
  • Remove race variables without addressing underlying algorithm design 
  • Overgeneralize or make claims based on limited data 

    The Systemic Approach

    Dr. Joseph Wright, Chief Equity Officer of the AAP, emphasizes that sustainable change requires addressing the complex “policy development ecosystem” that guides medical societies, including board governance and oversight; committee structures and processes; collaboration with sister societies; publication standards for journals; and integration with institutional protocols and EHR systems. This requires medical society leadership to make a significant investment in dedicated equity science teams, systematic review capabilities, stakeholder engagement, and board-level accountability. 

    Learn more about implementing evidence-based strategies in the Encoding Equity Stakeholder Toolkits. 

    Call to Action for Medical Societies

    1. Commit leadership and resources to systematic review of existing clinical guidance 
    1. Adopt comprehensive frameworks that address the full evidence-to-practice pipeline 
    1. Build infrastructure for sustained equity integration 
    1. Share learnings transparently to accelerate field-wide progress