Johns Hopkins University School of Medicine, Baltimore, Maryland.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Hosp Pediatr. 2023 Sep 1;13(9):784-793. doi: 10.1542/hpeds.2023-007138.
Children and youth in foster care (CYFC) have high rates of health care utilization, including inpatient care. The objective of this study was to explore the inpatient provider experience caring for CYFC.
Semistructured interviews were conducted with inpatient pediatric providers from Mid-Atlantic hospitals. Interview questions focused on 3 domains: provider training and preparedness, practice challenges, and strategies to improve care for CYFC. Conventional content analysis was applied to interview transcripts.
Thirty-eight interviews were completed with providers from 6 hospitals, including 14 hospitalists, 1 advanced practice provider, 11 registered nurses, 10 social workers (SWs), and 2 case managers. Nearly all (90%) reported at least monthly interactions with CYFC. Themes related to training and preparedness to care for CYFC included: medical providers' lack of formal training, limited foster care knowledge, and feeling of preparedness contingent on access to SWs. Themes related to unique practice challenges included: identifying CYFC, obtaining consent, documenting foster care status, complex team communication, and navigating interpersonal stress. Participants' suggestions for improving their ability to care for CYFC included increasing SW capacity, expanding provider training, standardizing electronic medical record documentation and order sets, and improving team communication and information sharing.
There are unique medical, social, and legal aspects of caring for hospitalized CYFC; pediatric medical providers receive limited training on these topics and rely heavily on SWs to navigate associated practice challenges. Targeted educational and health information technology interventions are needed to help inpatient providers feel better prepared to effectively meet the needs of CYFC.
寄养儿童（CYFC）的医疗保健利用率很高，包括住院治疗。本研究的目的是探讨照顾 CYFC 的住院提供者的经验。
对来自大西洋中部医院的住院儿科提供者进行半结构化访谈。访谈问题集中在 3 个领域：提供者培训和准备情况、实践挑战以及改善 CYFC 护理的策略。对访谈记录应用常规内容分析。
完成了来自 6 家医院的 38 名提供者的访谈，其中包括 14 名医院医生、1 名高级实践提供者、11 名注册护士、10 名社会工作者（SW）和 2 名个案经理。几乎所有（90%）提供者报告说他们至少每月与 CYFC 互动一次。与照顾 CYFC 的培训和准备相关的主题包括：医疗提供者缺乏正规培训、对寄养知识的了解有限以及在获得 SW 支持的情况下才有准备感。与独特的实践挑战相关的主题包括：识别 CYFC、获得同意、记录寄养状态、复杂的团队沟通以及处理人际压力。参与者提出了一些建议，以提高他们照顾 CYFC 的能力，包括增加 SW 能力、扩大提供者培训、标准化电子病历记录和医嘱集、以及改善团队沟通和信息共享。
照顾住院的 CYFC 具有独特的医疗、社会和法律方面，儿科医疗提供者对此类主题的培训有限，并且严重依赖 SW 来应对相关的实践挑战。需要有针对性的教育和健康信息技术干预措施，以帮助住院提供者更好地准备满足 CYFC 的需求。
