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Boss RD, Maddox K, Thorndike D, Keppel K, Batson L, Smith B, Weaver MS, Munoz-Blanco S. Building clinician-parent partnerships to improve care for chronically critically Ill children: A pilot project. PATIENT EDUCATION AND COUNSELING 2024; 122:108152. [PMID: 38232672 DOI: 10.1016/j.pec.2024.108152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Multicenter pilot to assess feasibility, acceptability, and educational value of videos for families and clinicians regarding unique inpatient challenges of pediatric chronic critical illness. METHODS Videos were developed for 3 hospitalization timepoints: 1) chronic critical illness diagnosis, 2) transfers, 3) discharge. Parents of hospitalized children, and interdisciplinary clinicians, were recruited to watch videos and complete surveys. RESULTS 33 parents (16 English-speaking, 17 Spanish-speaking) and 34 clinicians participated. Enrollment was better for families than clinicians (78% vs. 43%). Video acceptability was high: families and clinicians endorsed verisimilitude of depicted hospitalization challenges for chronic critical illness. All families felt the videos would help other families, all clinicians felt they would help other clinicians. Families gained expectations for the hospital course, discovered resources for hospitalization challenges, and learned there are other families in similar situations. Clinicians learned to recognize chronic critical illness, and how families experience hospitalizations, transfers, and discharges. CONCLUSION Educational videos about pediatric chronic critical illness were overall feasible, acceptable, and educational for hospitalized families and clinicians. PRACTICE IMPLICATIONS Just-in-time hospital education about pediatric chronic critical illness is valuable to families and clinicians; next steps are to assess potential to reduce gaps in care of children with chronic critical illness.
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Affiliation(s)
- Renee D Boss
- Johns Hopkins School of Medicine, 600 N. Wolfe St, Baltimore, MD 21287 USA; Johns Hopkins Berman Institute of Bioethics, 1801 Ashland Ave, Baltimore, MD 21287 USA.
| | - Katherine Maddox
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Dorte Thorndike
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Kristopher Keppel
- Johns Hopkins School of Medicine, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Lora Batson
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Brandon Smith
- Johns Hopkins School of Medicine, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | | | - Sara Munoz-Blanco
- Johns Hopkins School of Medicine, 600 N. Wolfe St, Baltimore, MD 21287 USA; The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
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Segal KR, Gomez JA, Schulz JF, Alvandi LM, Fornari ED. The Impact of Standardized Recovery Pathways on Language Barriers and Inpatient Pain Management. Hosp Pediatr 2023; 13:1001-1009. [PMID: 37850258 DOI: 10.1542/hpeds.2023-007232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Inpatient postoperative care is reliant upon clear, open communication between providers and patient-families, and thus is particularly vulnerable to disparities when discordant languages exist. It is not yet understood how standardized postoperative protocols may mitigate disparities related to language discordance. METHODS This is a retrospective cohort study among adolescent idiopathic scoliosis patients who underwent posterior spinal fusion at a tertiary care children's hospital in Bronx, New York after implementation of a postoperative pathway in 2017. Outcomes reliant upon communication between patient-families and providers were measured, including measures of pain management (number and type of pain medications requested, daily pain assessments, total opioids consumed), as well as outpatient pain scores. RESULTS A total of 160 patients were included (39 language other than English [LOE]). Between patient cohorts, there were no significant differences in demographic or operative characteristics. On univariate analyses, LOE patients were more likely to be given a basal dosing of patient-controlled analgesia or additional boluses (26% vs 12%, P = .03), consumed 0.53 fewer benzodiazepine medications per day (P = .01), and were more likely to have pain at outpatient follow-up (67% vs 43%, P = .03). On multivariate analyses, LOE patients were more likely to be placed on basally dosed or receive additional boluses of patient-controlled analgesia (odds ratio 3.19, 95% confidence interval 1.15-8.85). CONCLUSIONS As standardized pathways become more common in health care, it is critical to monitor for components of these protocols that may be vulnerable to language-related disparities, such as therapies reliant on symptom description and outpatient follow-up.
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Prochaska EC, Caballero TM, Fabre V, Milstone AM. Infection prevention requires attention to patient and caregiver language: Removing language barriers from infection prevention education. Infect Control Hosp Epidemiol 2023; 44:1707-1710. [PMID: 37039600 PMCID: PMC10691433 DOI: 10.1017/ice.2023.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- Erica C. Prochaska
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Health System, Baltimore, MD, USA
| | - Tania Maria Caballero
- Department of Pediatrics, Division of General Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valeria Fabre
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron M. Milstone
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Health System, Baltimore, MD, USA
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Khan A, Parente V, Baird JD, Patel SJ, Cray S, Graham DA, Halley M, Johnson T, Knoebel E, Lewis KD, Liss I, Romano EM, Trivedi S, Spector ND, Landrigan CP, Bass EJ, Calaman S, Fegley AE, Knighton AJ, O'Toole JK, Sectish TC, Srivastava R, Starmer AJ, West DC. Association of Patient and Family Reports of Hospital Safety Climate With Language Proficiency in the US. JAMA Pediatr 2022; 176:776-786. [PMID: 35696195 PMCID: PMC9194750 DOI: 10.1001/jamapediatrics.2022.1831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Patients with language barriers have a higher risk of experiencing hospital safety events. This study hypothesized that language barriers would be associated with poorer perceptions of hospital safety climate relating to communication openness. OBJECTIVE To examine disparities in reported hospital safety climate by language proficiency in a cohort of hospitalized children and their families. DESIGN, SETTING, AND PARTICIPANTS This cohort study conducted from April 29, 2019, through March 1, 2020, included pediatric patients and parents or caregivers of hospitalized children at general and subspecialty units at 21 US hospitals. Randomly selected Arabic-, Chinese-, English-, and Spanish-speaking hospitalized patients and families were approached before hospital discharge and were included in the analysis if they provided both language proficiency and health literacy data. Participants self-rated language proficiency via surveys. Limited English proficiency was defined as an answer of anything other than "very well" to the question "how well do you speak English?" MAIN OUTCOMES AND MEASURES Primary outcomes were top-box (top most; eg, strongly agree) 5-point Likert scale ratings for 3 Children's Hospital Safety Climate Questionnaire communication openness items: (1) freely speaking up if you see something that may negatively affect care (top-box response: strongly agree), (2) questioning decisions or actions of health care providers (top-box response: strongly agree), and (3) being afraid to ask questions when something does not seem right (top-box response: strongly disagree [reverse-coded item]). Covariates included health literacy and sociodemographic characteristics. Logistic regression was used with generalized estimating equations to control for clustering by site to model associations between openness items and language proficiency, adjusting for health literacy and sociodemographic characteristics. RESULTS Of 813 patients, parents, and caregivers who were approached to participate in the study, 608 completed surveys (74.8% response rate). A total of 87.7% (533 of 608) of participants (434 [82.0%] female individuals) completed language proficiency and health literacy items and were included in the analyses; of these, 14.1% (75) had limited English proficiency. Participants with limited English proficiency had lower odds of freely speaking up if they see something that may negatively affect care (adjusted odds ratio [aOR], 0.26; 95% CI, 0.15-0.43), questioning decisions or actions of health care providers (aOR, 0.19; 95% CI, 0.09-0.41), and being unafraid to ask questions when something does not seem right (aOR, 0.44; 95% CI, 0.27-0.71). Individuals with limited health literacy (aOR, 0.66; 95% CI, 0.48-0.91) and a lower level of educational attainment (aOR, 0.59; 95% CI, 0.36-0.95) were also less likely to question decisions or actions. CONCLUSIONS AND RELEVANCE This cohort study found that limited English proficiency was associated with lower odds of speaking up, questioning decisions or actions of providers, and being unafraid to ask questions when something does not seem right. This disparity may contribute to higher hospital safety risk for patients with limited English proficiency. Dedicated efforts to improve communication with patients and families with limited English proficiency are necessary to improve hospital safety and reduce disparities.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Victoria Parente
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Jennifer D. Baird
- Institute for Nursing and Interprofessional Research, Children’s Hospital Los Angeles, Los Angeles, California
| | - Shilpa J. Patel
- Department of Pediatrics, Hawaii Pacific Health, Honolulu,Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu
| | - Sharon Cray
- Department of Pediatrics, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania,Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
| | - Dionne A. Graham
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts,Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts
| | - Monique Halley
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
| | - Tyler Johnson
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Erin Knoebel
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Kheyandra D. Lewis
- Department of Pediatrics, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania,Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Isabella Liss
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Eileen M. Romano
- Department of Nursing, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Shrunjal Trivedi
- Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts
| | - Nancy D. Spector
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania,The Hedwig van Ameringen Executive Leadership in Academic Medicine Program, Philadelphia, Pennsylvania
| | - Christopher P. Landrigan
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Ellen J Bass
- Department of Information Science, College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania.,Department of Health Systems and Science Research, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
| | - Sharon Calaman
- Department of Pediatrics, New York University Grossman School of Medicine, New York.,New York University Langone Health/Hassenfeld Children's Hospital, New York
| | - April E Fegley
- Society of Hospital Medicine, Philadelphia, Pennsylvania
| | - Andrew J Knighton
- Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah
| | - Jennifer K O'Toole
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Theodore C Sectish
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Rajendu Srivastava
- Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah.,Department of Pediatrics, University of Utah School of Medicine, Salt Lake City.,Primary Children's Medical Center, Salt Lake City, Utah
| | - Amy J Starmer
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Daniel C West
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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