Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts;
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Pediatrics. 2020 Mar;145(3). doi: 10.1542/peds.2019-1264. Epub 2020 Feb 3.
Hospitals are rapidly increasing efforts to improve the pediatric inpatient experience. However, hospitals often do not know what to target for improvement. To determine what matters most to families, we assessed which aspects of experience have the strongest relationships with parents' willingness to recommend a hospital.
Cross-sectional study of 17 727 surveys completed from November 2012 to January 2014 by parents of children hospitalized at 69 hospitals in 34 states using the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey. Hierarchical logistic regressions predicted the "top box" for willingness to recommend from measures of specific care dimensions (nurse-parent communication, doctor-parent communication, communication about medicines, keeping parents informed about the child's care, privacy with providers, preparing to leave the hospital, mistakes and concerns, child comfort, cleanliness, and quietness), adjusting for parent-child characteristics. Relative importance was assessed by using partially standardized adjusted odds ratios (aORs).
Child comfort (aOR 1.50; 95% confidence interval 1.41-1.60) and nurse-parent communication (aOR 1.50; 95% confidence interval 1.42-1.58) showed the strongest relationships with willingness to recommend, followed by preparing to leave the hospital, doctor-parent communication, and keeping parents informed. Privacy and quietness were not significantly associated with willingness to recommend in multivariate analysis.
Our study uncovered highly valued dimensions that are distinct to pediatric care. Hospitals that care for children should consider using dedicated pediatric instruments to measure and track their performance. Improvement efforts should focus on creating an age-appropriate environment, improving the effectiveness of provider interactions, and engaging parents to share their values and concerns.
医院正在迅速加大力度改善儿科住院患者的体验。然而，医院通常不知道要针对哪些方面进行改进。为了确定对家庭最重要的因素，我们评估了体验的哪些方面与父母推荐医院的意愿关系最密切。
对 2012 年 11 月至 2014 年 1 月期间在 34 个州的 69 家医院住院的 17727 名儿童的家长进行横断面调查，使用儿童医院消费者评估医疗保健提供者和系统调查量表评估家长对特定护理维度（护士与家长沟通、医生与家长沟通、关于药物的沟通、向家长通报患儿治疗情况、与医护人员的隐私保护、准备出院、失误和顾虑、患儿舒适度、清洁度和安静程度）的“最满意”评价意愿。采用分层逻辑回归预测“最满意”评价意愿，调整了患儿和家长的特征。通过部分标准化调整后的优势比（aOR）评估相对重要性。
患儿舒适度（aOR 1.50；95%置信区间 1.41-1.60）和护士与家长沟通（aOR 1.50；95%置信区间 1.42-1.58）与推荐意愿关系最密切，其次是准备出院、医生与家长沟通、向家长通报患儿治疗情况。在多变量分析中，隐私保护和安静程度与推荐意愿无显著相关性。
我们的研究揭示了儿科护理中具有独特价值的重要维度。儿科护理医院应考虑使用专门的儿科工具来测量和跟踪其绩效。改进工作应侧重于创造适合患儿年龄的环境、提高医护人员互动的有效性，并让家长参与，分享他们的价值观和关注点。
