354 - Investigating Disparities in Patient and Family Experience on Pediatric Hospital Medicine Teams

Publication Number: 4347.354

Margaret Ridge, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Chen Chen, Cincinnati Children's Hospital Medical Center, Basking Ridge, NJ, United States; Bin Huang, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Ndidi Unaka, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States; Andrew F. Beck, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Patrick W. Brady, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Patients who identify as racial and ethnic minorities are less likely to be satisfied with their hospital experience and more likely to have poor communication on family-centered rounds (FCR), the primary communication touchpoint during hospitalization. High quality team-family communication can enhance patient family experience (PFE).

Objective: We aimed to (1) evaluate the association between patient-family demographic characteristics and PFE survey responses following pediatric hospitalizations; (2) assess the degree to which caregiver presence on FCR explained disparities in PFE measures. We hypothesized that caregivers of patients who identify as Black, are publicly insured, or have caregivers that prefer a language other than English would be less likely to have top-box scores on communication-focused questions, and that analyses adjusted for FCR presence would reduce but not eliminate disparities in PFE outcomes.

Design/Methods: We performed a retrospective cohort study of PFE data from 5/9/2023 to 11/10/2024 following hospitalization at an urban pediatric academic hospital. To reduce bias and represent the full population, we performed inverse probability weighting to account for missing data. Our exposures were demographic variables, including patients' race, insurance and caregiver language preference (Table 1). Our outcome of interest was top-box scores on communication-focused PFE questions. To examine whether caregiver presence during FCR mediated the relationship between demographic characteristics and PFE responses, we compared regression coefficients before and after FCR adjustment.

Results: A total of 1809 PFE survey responses were analyzed. Caregivers of Black patients were less likely to endorse (1) feeling safe and (2) understandable explanations from nurses. We evaluated other demographic factors, serving as proxies for systemic racism and interpersonal bias, including caregiver language and patient insurance, which were associated with several poorer PFE survey outcomes (Table 2). Caregiver presence during FCR was associated with positive responses in several PFE domains. However, demographic disparities in top-box PFE survey responses persisted regardless of caregiver presence on FCR.

Conclusion(s): Disparities in PFE outcomes in communication, safety, and respect domains were identified for patients who are Black, publicly insured, and have caregivers who speak languages other than English or Spanish. FCR presence did not appear to mediate disparities in PFE survey responses. Improvement work targeting and narrowing identified disparities is indicated.

Patient Demographic Characteristics
Includes survey population demographic characteristics including primary and secondary exposures, patient race and insurance, and caregiver language.

Factors Associated with Caregiver-Reported Top-Box Scores on Post-Discharge Hospital Medicine Patient-Family Experience Survey
Results of multivariable logistic regression analysis, assessing the association between exposures and PFE survey question responses, accounting for covariates and the mediator, caregiver presence.