191 - Does Simplification Improve Family Member Safety Reporting? Findings from a Mobile Health Tool Randomized Trial

Publication Number: 4188.191

Danea Horn, University of California, San Francisco, San Francisco, CA, United States; Anjana E. Sharma, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Nancy Netherland, Kids and Caregivers, Nevada City, CA, United States; Deborah Franzon, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Helen Pu, University of California San Francisco, San Francisco, CA, United States; Leslie Magana, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Urmimala Sarkar, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Glenn Rosenbluth, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Jessica M. Pequeno, UCSF Childrens Hospital, Napa, CA, United States; john boscardin, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Alicia Fernandez, University of California, San Francisco, San Francisco, CA, United States; Naomi Bardach, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Background: Mobile phone technology provides an opportunity to gather safety observations directly from family members of hospitalized patients. In our prior research using a co-designed mobile phone tool to gather real-time safety observations, family members with less education and lower digital literacy reported less often. In light of these disparities, some family advisors suggested simplifying the tool, while others suggested keeping the standard version, which provides a detailed listing of potential safety events to prompt event recall.

Objective: To test a simplified version of the mobile phone safety reporting tool versus the standard version, using reporting rates, content, and length as outcomes.

Design/Methods: Randomized 1:1 controlled trial nested within a larger trial of the tool, 9/23-3/24, across 3 hospitals. Participants were English- or Spanish-speaking family members of pediatric inpatients, 0-21 years. We randomly assigned participants to a daily text with either the standard or simplified tool (Figure 1), which were co-designed with family advisors. The standard tool included safety categories with simple icons and safety sub-categories, plus a category to make positive reports, followed by a free-text box to provide narrative data. The simplified tool did not provide sub-categories. We compared the number of observations/100 study-days by tool version, using Poisson regression, and estimated heterogeneity using interaction terms for caregiver characteristics. We compared tool version content categories using Chi-square testing. We compared mean #words/observation by tool version using t-testing.

Results: 469 participants submitted 289 reports (8.8 observations/100 study-days). More observations were reported in the standard tool group than the simplified group (10.8 observations/100 study-days vs 6.7, p< 0.001). Spanish-speakers and people who reported less education also used the standard tool more than the simplified tool; this difference persisted across most characteristics (Figure 2). Content categories were similar across groups (p=0.24), as was length of observations (mean 42 words/observation in both groups).

Conclusion(s): A simplified mobile-phone reporting tool did not result in greater safety reports compared to a standardized tool for pediatric inpatient caregivers. This may reflect the family input during the standardized tool design, as well as nudges provided by the detailed list of possible events in the standardized tool. A more granular interface may be more effective than a simple one in engaging caregivers in safety reporting, when co-designed with families.

Figure 1. Screenshots of FIQS Mobile Phone Tool Interface to Gather Safety Reports
Notes: Family Input into Quality and Safety (FIQS) tool selected screenshots. Screenshot 1 shows the categories for event reporting. Screenshot 2 shows the main categories, and Screenshot 3 shows the subcategories related to choosing Communication; Screenshot 3 is only in the standard tool.  

Figure 2