Quality of Care at a Children's Hospital

Homer, Charles J.; Marino, Barbara L.; Cleary, Paul D.; Alpert, Hillel R.; Smith, Barbara J.; Ganser, Constance M. Crowley; Brustowicz, Robert M.; Goldmann, Donald A.

doi:10.1001/archpedi.153.11.1123

Cited by 113 publications

(90 citation statements)

References 11 publications

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“…6,7 Previous studies have not focused on differences between communication during the day and night, however. Over the past decade, hospitals have increasingly moved toward care models in which different teams of providers care for patients by day and by night.…”

Section: Discussionmentioning

confidence: 99%

Physician and Nurse Nighttime Communication and Parents’ Hospital Experience

Khan

Rogers²,

Melvin

et al. 2015

Pediatrics

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Section: Discussionmentioning

confidence: 99%

Physician and Nurse Nighttime Communication and Parents’ Hospital Experience

Khan

Rogers²,

Melvin

et al. 2015

Pediatrics

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“…Previous work has shown that minorities and those with chronic disease are less satisfied with hospital care [9],leading one to believe that minority parents of children with SCD and asthma would both report increased dissatisfaction with hospital care. This was not the case in our study, nor was there a difference when the minority group was restricted to African-Americans.…”

Section: Discussionmentioning

confidence: 99%

“…This question allows five possible answers on a 5-point Likert scale, with 1 ¼ poor and 5 ¼ excellent. Similar to previous studies, we dichotomized the outcome, with responses of 1 (poor) to 3 (good) indicating dissatisfaction, and scores of 4 (very good) and 5 (excellent) indicating parent satisfaction with hospital care [9,12].…”

Section: Outcome Measuresmentioning

confidence: 99%

“…Previous studies evaluating parent reported satisfaction with hospital care for children with all diagnoses found that minority children and children with chronic illness receive lower quality care [9]. Given that SCD is a chronic illness and almost exclusively affects minority children, one would expect that parents of children with SCD would report lower satisfaction with care compared to other children.…”

Section: Introductionmentioning

confidence: 99%

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Dissatisfaction with hospital care for children with sickle cell disease not due only to race and chronic disease

Brousseau

Mukonje

Brandow

et al. 2009

Pediatric Blood & Cancer

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BackgroundA previous study reported increased dissatisfaction with hospital care for children with sickle cell disease (SCD); however, its small size excluded determining whether race and chronic disease explained the difference.ProcedureAt hospital discharge, parents of children with SCD completed a survey assessing satisfaction with their child's hospital care. Results were compared to three years of satisfaction surveys for children with asthma or admitted to a general pediatrician's service collected as quality improvement for the hospital. The primary outcome was parent reported dissatisfaction with care. A chi‐square was used to compare dissatisfaction between SCD and each comparison group.ResultsParents of 639 children were included, 34 children with SCD, 124 with asthma, and 481 general pediatric patients. Parents of children with SCD were more often dissatisfied with their child's care compared to children with asthma (32.4% vs. 16.9%, P < 0.05) and general pediatric patients (32.4% vs. 14.6%, P < 0.05). Among all children, dissatisfaction was higher in families with minority children (21.1% vs. 12.6%); this difference did not exist among children with asthma. Among African‐American children, a higher proportion of parents of children with SCD believed their child was treated differently because of race than children with asthma (45.5% vs. 2.8%, P < 0.01) or general pediatric patients (45.5% vs. 8.3%, P < 0.01).ConclusionParents of children with SCD report increased dissatisfaction with care. While dissatisfaction was higher in minority families, the high rate of parental concern about race as a reason for families of children with SCD is not seen in African‐American families of children with asthma. Pediatr Blood Cancer 2009;53:174–178. © 2009 Wiley‐Liss, Inc.

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“…Questions that were specific to these domains were chosen from the National Research Corporation/Picker survey modified and validated by researchers at Children's Hospital Boston and used to survey parents' report of their child's care. 13,14 A total of 11 questions form the partnership domain, and 7 form the information-giving domain (Table 1 lists questions for each domain). The mean number of problems reported by the parent for each domain served as the primary outcome.…”

Section: Outcome Measuresmentioning

confidence: 99%

Impact of Patient-Centered Decision Support on Quality of Asthma Care in the Emergency Department

et al. 2006

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OBJECTIVE. Communication barriers between parents of children with asthma and clinical emergency department (ED) providers and subsequent underrecognition of chronicity and severity impede improvements in disease management for patients with asthma in the ED setting. The asthma kiosk, a novel patient-driven decision-support tool, provides ED clinicians with tailored recommendations for guideline-based treatment. We evaluated the impact of the asthma kiosk on measures of quality during ED care, specifically, parent-reported satisfaction with dimensions of care related to communication and providers' adoption of guidelineendorsed processes of care. METHODS.A clinical trial composed of a baseline and an intervention period was conducted at a single tertiary care pediatric ED. Eligible participants were Englishor Spanish-speaking parents of children who were 1 to 12 years of age and had a respiratory complaint and history of asthma. Parents used the kiosk to report children's symptoms, current medications, and unmet needs. During a 2-month baseline, no output from the kiosk was shared, and usual care proceeded. During a 3-month intervention that followed a 1-week run-in period, the output was shared with ED clinicians. All parents completed a telephone follow-up interview 1 week after discharge. Primary outcomes were (1) prescription of controller medication to patients who had persistent asthma symptoms and were not on controllers and (2) mean problem scores for 2 specific dimensions of care: information-sharing and partnership.RESULTS. Over 5 months, 1090 parent-child dyads were screened and 430 were eligible. A total of 286 (66.5%) of 430 parents enrolled in the trial. The kiosk generated severity classifications for 264 (92.3%) of 286 children. A total of 131 parents enrolled during baseline, 13 during a 1-week test phase, and 142 during intervention. Baseline participants were older (mean age: 5.3 years) compared with intervention (4.4 years) but did not differ on chronic severity, current use of controllers, or race. The total number of prescribed inhaled corticosteroids did not vary significantly between intervention and baseline (9 of 50 vs 4 of 43). Providers did prescribe inhaled fluticasone to eligible patients more often during intervention than baseline (9 of 50 vs 2 of 43). The number of reported information problems was unchanged between the baseline and intervention periods. The mean number of partnership problems increased from a mean of 1.5 (SD: 1.9) at baseline to a mean of 1.9 (SD: 1.4) during the intervention. This difference was marginally significant after adjustment for child gender, age, and severity category. When ED providers acted on kiosk data, reports of information problems were fewer (0.6 Ϯ 0.8) than when no action was taken (1.1 Ϯ 1.1).CONCLUSIONS. The asthma kiosk demonstrated small and variable impact on quality. Physicians' nonuse of kioskgenerated recommendations may explain the limited impact of the intervention. O PTIMAL HEALTH CARE requires effective collaboration betw...

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Quality of Care at a Children's Hospital

Cited by 113 publications

References 11 publications

Physician and Nurse Nighttime Communication and Parents’ Hospital Experience

Physician and Nurse Nighttime Communication and Parents’ Hospital Experience

Dissatisfaction with hospital care for children with sickle cell disease not due only to race and chronic disease

Impact of Patient-Centered Decision Support on Quality of Asthma Care in the Emergency Department

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