Center for Child Health, Behavior and Development (K Casey Lion, KC Arthur, MF García, LJ Sotelo Guerra, H Chisholm, BE Ebel, C Zhou, and R Mangione-Smith), Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics (K Casey Lion, E Griego, BE Ebel, C Zhou, and R Mangione-Smith), University of Washington School of Medicine, Seattle, Wash.
Center for Child Health, Behavior and Development (K Casey Lion, KC Arthur, MF García, LJ Sotelo Guerra, H Chisholm, BE Ebel, C Zhou, and R Mangione-Smith), Seattle Children's Research Institute, Seattle, Wash.
Acad Pediatr. 2024 Jan-Feb;24(1):33-42. doi: 10.1016/j.acap.2023.06.021. Epub 2023 Jun 22.
Children with low income and minority race and ethnicity have worse hospital outcomes due partly to systemic and interpersonal racism causing communication and system barriers. We tested the feasibility and acceptability of a novel inpatient communication-focused navigation program.
Multilingual design workshops with parents, providers, and staff created the Family Bridge Program. Delivered by a trained navigator, it included 1) hospital orientation; 2) social needs screening and response; 3) communication preference assessment; 4) communication coaching; 5) emotional support; and 6) a post-discharge phone call. We enrolled families of hospitalized children with public or no insurance, minority race or ethnicity, and preferred language of English, Spanish, or Somali in a single-arm trial. We surveyed parents at enrollment and 2 to 4 weeks post-discharge, and providers 2 to 3 days post-discharge. Survey measures were analyzed with paired t tests.
Of 60 families enrolled, 57 (95%) completed the follow-up survey. Most parents were born outside the United States (60%) with a high school degree or less (60%). Also, 63% preferred English, 33% Spanish, and 3% Somali. The program was feasible: families received an average of 5.3 of 6 components; all received >2. Most caregivers (92%) and providers (81% [30/37]) were "very satisfied." Parent-reported system navigation improved from enrollment to follow-up (+8.2 [95% confidence interval 2.9, 13.6], P = .003; scale 0-100). Spanish-speaking parents reported decreased skills-related barriers (-18.4 [95% confidence interval -1.8, -34.9], P = .03; scale 0-100).
The Family Bridge Program was feasible, acceptable, and may have potential for overcoming barriers for hospitalized children at risk for disparities.
由于系统和人际种族主义导致沟通和系统障碍，低收入、少数族裔和种族的儿童的住院治疗结果更差。我们测试了一种新型住院患者以沟通为重点的导航计划的可行性和可接受性。
与父母、医务人员和员工进行多语言设计研讨会，创建了家庭桥梁计划。由经过培训的导航员提供，包括 1）医院定向；2）社会需求筛查和响应；3）沟通偏好评估；4）沟通辅导；5）情感支持；和 6）出院后电话。我们在一项单臂试验中招募了有公共保险或无保险、少数民族和种族以及首选英语、西班牙语或索马里语的住院儿童的家庭。我们在入组时和出院后 2 至 4 周对父母进行了调查，并在出院后 2 至 3 天对医务人员进行了调查。采用配对 t 检验分析调查措施。
在 60 个入组家庭中，有 57 个（95%）完成了随访调查。大多数父母（60%）出生在美国境外，且只有高中学历或以下（60%）。此外，63%的人首选英语，33%的人首选西班牙语，3%的人首选索马里语。该计划具有可行性：家庭平均接受了 6 个环节中的 5.3 个；所有人都接受了超过 2 个环节。大多数照顾者（92%）和医务人员（81%[30/37]）都“非常满意”。父母报告的系统导航从入组到随访有所改善（+8.2[95%置信区间 2.9，13.6]，P=0.003；0-100 分制）。讲西班牙语的父母报告说技能相关障碍减少了（-18.4[95%置信区间-1.8，-34.9]，P=0.03；0-100 分制）。
家庭桥梁计划是可行的、可接受的，并且可能有潜力克服有差异风险的住院儿童的障碍。
