373 - The Relationship between In-Hospital Communication and Post-Discharge Healthcare Utilization

Publication Number: 4365.373

Victoria Parente, Duke University School of Medicine, Durham, NC, United States; Claire Hailey, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Michelle White, Duke University School of Medicine, Durham, NC, United States; David Ming, Duke University School of Medicine, Durham, NC, United States

Background: Negative healthcare experiences, including perceiving discrimination or disrespect, are associated with future healthcare avoidance or delays in seeking care. While hospitalization is a single point in a child’s continuum of care, we predicted that poor hospital experiences was associated with future healthcare utilization including missed hospital follow-up appointments, delays in seeking care, and increased hospital readmission.

Objective: To evaluate associations between caregiver-reported in-hospital communication and post-discharge healthcare utilization.

Design/Methods: We conducted a secondary analysis of caregiver surveys and administrative data collected as part of two studies investigating clinician-caregiver communication from 11/2022-08/2023 and 01/2024-03/2025. Included caregivers were aged ≥18 and spoke English or Spanish, had children admitted to a general pediatric service. Validated surveys captured satisfaction and clinician communication in several domains. We performed a chart review to measure if a child was readmitted within 30 days of discharge, had a “no show” encounter within 6 months of discharge, and to count the number of follow-up appointments listed on the child’s discharge summary that the child attended. Follow up appointments were dichotomized to none or at least one. We used logistic regression to measure associations between survey measures and post-discharge outcomes clustered by study.

Results: Among the children of the 157 caregiver participants surveyed, 37% had at least one no show and 8.9% were readmitted within 30 days. Majority (n=125, 80%) had at least one follow up appointment scheduled on their discharge summary; 62% attended all follow-ups, 22% some, and 16% did not attend any. In logistic regression models, having at least one “no show” encounter was higher in caregivers who reported decreased satisfaction communicating with medical team, lower feelings of their concerns being elicited, and higher reports of discrimination (Table 2). Children were more likely to be readmitted within 30 days when their caregiver reported higher shared-decision making and less discrimination (Table 2). There was no association between not attending any follow up appointments and communication measures.

Conclusion(s): In this study, experiences of discrimination and poor communication was associated with avoidant behaviors including greater likelihood of a no show encounter and less likelihood of being readmitted within 30 days. Further studies are needed to understand the relationship between hospital communication and post-discharge outcomes.

Table 1: Patient Characteristics
Table2_PAS_CombinedOutcomes.pdf

Table 2: Relationship between In-Hospital Communication and Post-Discharge Healthcare Utilization
Table2_PAS_CombinedOutcomes.pdf