612 - Pediatrician perspectives on barriers and facilitators to discharge instruction comprehension and adherence for parents of children with medical complexity

Poster Number: 612
Publication Number: 612.404

Alexander F. Glick, NYU Grossman School of Medicine, New York, NY, United States; H. Shonna Yin, NYU Grossman School of Medicine, New York City, NY, United States; Benjamin Silva, New York University Grossman School of Medicine, New York, NY, United States; Julia S. Turock, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Jonathan S. Farkas, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Avani C. Modi, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Emily J. Goodwin, Children's Mercy Kansas City, Kansas City, MO, United States; Vincent Huynh, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Hannah S. Famiglietti, New York University Grossman School of Medicine, New York, NY, United States; Victoria V. Dickson, NYU Meyers College of Nursing, New York, NY, United States

Background: High rates of post-hospitalization readmissions and errors are observed in children with medical complexity (CMC); poor parent comprehension and adherence to inpatient discharge instructions likely contribute to these errors. Pediatrician views on common barriers and facilitators to parent comprehension and adherence are understudied.

Objective: To examine pediatrician perspectives on barriers and facilitators experienced by parents in comprehension of and adherence to discharge instructions for CMC after an inpatient hospitalization.

Design/Methods: We conducted a qualitative, descriptive study of a purposeful sample of attending pediatricians (n=20) caring for CMC in inpatient settings (US and Canada) and belonging to listservs for pediatric hospitalists/complex care providers. We used maximum variation sampling to ensure heterogeneity (e.g., hospital, region). A multidisciplinary team designed and piloted a semi-structured interview guide with members of the target population. Trained team members conducted semi-structured interviews via phone or video call. Interviews were audiorecorded and transcribed. We analyzed transcripts using content analysis (Dedoose Version 9.0.17). We derived codes a priori from a conceptual framework (based on the Pediatric Self-Management Model and existing literature) and a preliminary analysis of transcripts. We applied codes and subsequently identified emerging themes from transcripts. Methodologic rigor was supported via member checking, peer debriefing, and 2 coders for a subset of transcripts.

Results: We identified 4 themes among participants (Table 1): 1) Lack of access to care and appropriate resources, including physician access, home care, transportation, insurance, and available materials for families with limited English proficiency (Table 2); 2) Challenges associated with child and regimen complexity (especially for children who are newly medically complex) (Table 2); 3) Importance of teamwork and relationship building (Table 3); and 4) Need for a patient- and family-centered and structured approach to discharge planning, including accommodating schedules/competing priorities, understanding support systems, ensuring enough time for discharge counseling and comfort with post-discharge care, and tailoring education (Table 3).Conclusion(s): Pediatricians identified several barriers and facilitators to discharge instruction comprehension and adherence for parents of CMC. Next steps include assessment of parent perspectives and development of intervention strategies.
Table 1
Table 2