Equity in Primary Care: A Q&A With Dr. Tumaini Coker, New Division Chief of General Pediatrics

Tumaini Coker, MD, MBA, took on a new role as Seattle Children’s division chief of general pediatrics in January 2021.

A lot of people don’t know exactly what Seattle Children’s General Pediatrics division is. Can you tell us about its purpose and makeup?

Dr. Tumaini Coker

Dr. Coker: We are a group of nearly 60 faculty in academic general pediatrics. We are clinicians, educators, researchers and advocates. Our faculty members practice primary care pediatrics and teach students and residents across multiple clinical sites, such as Odessa Brown Children’s Clinic, Harborview Pediatric Clinics and UW Neighborhood clinics, to name a few. Faculty investigators conduct research across a wide range of topics that impact child and family health and wellness, from autism, to concussion in young athletes, to environmental health. In addition to our clinical and research programs, we have multiple fellowship training programs, including our newest fellowship in Child Health Equity Research, and fellowships in pediatric injury research, health services and quality of care research, child abuse medicine and sports medicine.

What are your main priorities as the new division chief?

Dr. Coker: We will of course continue to focus on excellence in the main pillars of academic medicine — clinical care, research, teaching and advocacy. But we will do this with a renewed and laser focus on health equity and improving care for historically disadvantaged populations. It’s something we will be very intentional about. Related to that, my hope is that we really can transform the way that primary care is provided, moving towards a more equitable, team-based approach to care that truly meets the comprehensive needs that families living in poverty have. We can achieve this through integrating clinical care with research and by making sure our work as an academic division is translatable into clinical care in the community.

What does focusing on health equity look like in practice?

Dr. Coker: I think it is about intentionally designing our improvement efforts to have the most impact on those children and families suffering from the inequities in our current system. A focus on health equity means that every new intervention, innovation or other improvement in care must be designed specifically for these families. And we cannot be afraid to have that explicit focus, because without it, I don’t think we can ever achieve health equity.

As an academic division, it is also important for us to spread innovation beyond our own walls to help eliminate healthcare disparities for children in our region. In academic medicine, we need to be doing much better on this front. Part of the problem is that when we as academics have new knowledge to share, we typically publish it in medical and clinical journals and talk about it at conferences. That is not enough. We need to find better ways of sharing what we have learned so that families, community organizations and healthcare providers in the community can actually put it to use.

Can you describe some of your own research underway now?

Dr. Coker: In my own research lab, we are currently testing the use of a parent coach as part of well-child care visits for children ages 0 to 3 living in poverty. Research has shown that the use of an expanded care team with people like health navigators, health coaches and health educators, who have shared life experiences and cultural relevance with families, can really improve care. In our work, we partnered with community clinics that serve a Medicaid-insured population to study team-based care for well-child care. The parent coach is part of the well-child care team in these clinics and provides anticipatory guidance, social needs screening and resources and developmental and behavioral health screening and guidance. We’ve reported findings on this model of care that shows greater quality of well-child care services and a significant reduction in emergency department utilization with the intervention compared to control, but more to come as we complete the current study that includes over 900 families and 10 clinical sites across Washington and California.

What does it mean to transform primary care?

Dr. Coker: In the big picture, it is this question of how we provide primary care to meet families’ needs in a comprehensive, integrated way that brings us closer to health equity. The details of how this is done, however, is in the structure of care — who is part of the team providing the care and how that team works together, and with the community and the family, to provide culturally relevant services that meet the full health and wellness needs that every child needs to reach their full potential. This includes behavioral and mental health, social needs, care navigation and coordination and community partnerships for health.

Historically, incentives in primary care kept healthcare providers isolated from those who provide other critical health and wellness services for kids in sectors such as early childhood education and social services. But the needs of children and their families require better partnerships with these sectors — organizations such as food banks, advocacy groups, social services, schools, preschools and after-school education programs. Without these partnerships, our primary care system remains isolated from the critical services that families need.

Clearly a major barrier is resources. As an academic division at Seattle Children’s and our other sites, however, we have more resources than a small practice does. As we figure out how we do community partnerships and get behavioral health integrated into care, we need to ask how does that help a small practice that doesn’t have the same resources? We have to think about making our work generalizable, because most kids are being served out in the community and not within an academic medical center. We are in the early stages of this work, but we are determined to make an impact.

How do you stay connected with patients and families?

Dr. Coker: I am a pediatrician at Odessa Brown Children’s Clinic. It’s impossible to do research on transforming primary care without being in the clinic and seeing the actual intricacies of delivering care. Caring for patients at OBCC and seeing team-based care in action informs my research around how comprehensive care goes beyond meeting medical needs to improving a family’s well-being as a whole.

More about Dr. Coker

Dr. Coker practices primary care and teaches medical students and residents at Seattle Children’s Odessa Brown Children’s Clinic. Her research focuses on working with community clinics and pediatric practices to design and test innovative models of delivering primary care services to children in low-income communities, using telehealth to improve behavioral health services and addressing socioeconomic disparities in care for children. She is associate professor of pediatrics at the University of Washington.

Dr. Coker’s research has been recognized nationally through several prestigious awards, including Academy Health’s Nemours Child Health Services Research Award, the Association of American Medical Colleges (AAMC) Herbert W. Nickens Faculty Fellowship for contributions to promoting healthcare equity, the Pediatric Heroes Award from Babytalk magazine for research on improving the health of families living in poverty and the National Medical Association’s Council on Concerns of Women Physicians Research Award. Dr. Coker is a member of the National Academies of Sciences, Engineering, and Medicine’s Committee on Implementing High Quality Primary Care and the American Academy of Pediatrics’ (AAP) Bright Futures 4th Edition National Preventive Care Guidelines Expert Panel and its National Advisory Board for its Social Determinants of Health Quality Improvement Initiative.

Dr. Coker completed her undergraduate education at Stanford University and received an MBA at the UCLA Anderson School of Management. She received an MD at the Drew/UCLA Medical Program at the David Geffen School of Medicine at UCLA and completed a pediatric residency at Cedars-Sinai Medical Center. She was a Robert Wood Johnson Clinical Scholar at the University of Chicago from 2004 to 2006.