185 - Inequities in Communication during General Pediatric Inpatient Family Centered Rounds

Publication Number: 185.5218

Christine Cummings, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Chris Bonafide, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Nicolas P. Goldstein Novick, Children's Hospital of Philadelphia, Rose Valley, PA, United States; Kristin Maletsky, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Jessica Nguyen, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Megan Ellis, Childrens Hospital of Philadelphia, Springfield, PA, United States; Olivia O. Familusi, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Aditi Vasan, Children's Hospital of Philadelphia, Philadephia, PA, United States; Tiffani J. Johnson, UC Davis, Sacramento, CA, United States

Background: Pediatric patients from minoritized racial and ethnic backgrounds are at increased risk of adverse health outcomes. Differences in families’ experiences of care during pediatric hospitalizations may contribute to these inequities. Previous studies have found that Black and Latinx caregivers of pediatric patients report being treated with less respect than white caregivers on inpatient rounds. No prior studies have quantified differences in caregiver engagement in rounds based on child race and ethnicity.

Objective: To examine the association between patient demographic characteristics and inpatient rounding structure, including (1) caregiver presence on rounds, (2) time spent with families during rounds, and (3) questions asked by patients and family members during rounds. We hypothesized that inpatient general pediatrics teams may spend less time rounding with minoritized families, and that these families may have fewer opportunities to ask questions during rounds.

Design/Methods: This observational study focused on rounds on two inpatient general pediatrics teams at a pediatric quaternary care hospital. We conducted daily rounds observations to assess caregiver presence, time spent with caregivers, and number of questions asked. We abstracted patient demographic and clinical information from the Electronic Health Record. We used multivariable regression to examine the association between patient race and ethnicity and inpatient rounding structure, after adjusting for clinical characteristics.

Results: Across 305 observed patient encounters, 48.5% of children were Non-Hispanic Black (NHB), 18.7% were Hispanic, and 65.2% were publicly-insured (Table 1). Compared to Non-Hispanic White (NHW) families, NHB and Hispanic families were less likely to be present on rounds (71.6% and 80.7% vs 95.0%, p< 0.001). Among the 247 families who were present on rounds, after accounting for relevant covariates, care teams spent 1.3 fewer minutes rounding with NHB families (95% CI 0.4 to 2.1) and 1.9 fewer minutes rounding with Hispanic families (95% CI 0.7 to 3.1) as compared to NHW families. NHB and Hispanic families also asked significantly fewer questions on rounds (Table 3).

Conclusion(s): As compared to NHW families, NHB and Hispanic families were less likely to be present on general pediatric inpatient rounds, and when present, spent less time with the clinical team and asked fewer questions. Pediatric hospitals should work to ensure equitable participation in inpatient rounds in order to mitigate inequities in families’ experiences of care and promote equitable child health outcomes.

Table 1. Demographics, Health Status, and Medical Utilization by Patient Race/Ethnicity
1 Fisher’s Exact Test, 2 Poisson Regression, 3 Anova; total sample discharged at time of analysis: 87; Missingness: gender (2), insurance (13), admitted from location (1), admitted in last 30 days (8)

Table 2. Family Presence at Rounds, Duration of Discussion, and Number of Questions Asked by Patient Race/Ethnicity
1 Anova, 2 Poisson Regression, 3 Fisher’s Exact Test

Table 3. Univariate and Multivariate Analyses Assessing Family Presence at Rounds, Duration of Discussion, and Number of Questions Asked by Race/Ethnicity
# Logistic Regression, * Linear Regression, ^ Poisson Regression; 1 Controlling for preferred language, number of diagnoses on problem list, admission location, admission in last 30 days, and social work consult