295 - Is stress associated with healthcare satisfaction among families of children with medical complexity? A project on routine caregiver mental health screening to improve quality & effectiveness of care

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 295
Publication Number: 295.204

Oluwaseyi Oni, Baystate Children's Hospital, Springfield, MA, United States; Ethan W. Kellogg, New York Medical College, New York, NY, United States; dafne Alexa. sanabria Garcia, New York Medical College, Detroit, MI, United States; Evelyne Cumps-Bakst, Metropolitan Hospital, new york city, NY, United States

Presenting Author(s)

Oluwaseyi Oni, MD MPH

Pediatric Hospitalist
Baystate Children's Hospital
Metropolitan Hospital Center

Background: Parents of children with medical complexity (CMC) are vulnerable to stress, directly or indirectly related to their child's condition. Parental mental health affects the health and well-being of CMC and impacts the effectiveness of medical care they receive. To provide family-centered, comprehensive care, a systematic way of eliciting and addressing the psychosocial needs of families is needed. To achieve this, routine screening of caregivers of CMC for psychological stress during clinic visits in order to uncover and address unmet needs was implemented in a quality improvement project in a safety net hospital in New York City. Those who screened positive were provided with tailored interventions, such as transportation, mental health resources, health services or community programs.

Objective: The main objective of this project is to improve healthcare quality and satisfaction for families with CMC. The secondary objective is to estimate the prevalence of stress among families of CMC and explore its relationship with healthcare satisfaction.

Design/Methods: Caregivers of CMC were screened for psychological stress using the Perceived Stress Scale-4. Satisfaction with care received was assessed using an after-visit survey. Our process measure was the percentage of families screened. Our outcome measure was the percentage of families reporting satisfaction with their visit. The relationship between stress and satisfaction was analyzed using logistic regression.

Results:
Baseline data showed that 50% of families were satisfied with their visit. This increased to 75% in the first month of screening and remained at or greater than 75% (goal was 65%). We reached and consistently surpassed our goal of screening at least 65% of families each month by the third month.

52% of families screened positive for stress. 86% of those who screened negative for stress were satisfied with their care. 57% of those who screened positive for stress were satisfied with their care. The odds of satisfaction were significantly different for families who screened negative compared to those who screened positive [OR 4.59, p-value 0.02]. The COVID-19 pandemic did not cause a significant change in satisfaction (χ2 2.3, p=0.129) or stress (χ2 0.1, p=0.74).

Conclusion(s): Families of CMC experience high levels of stress, and this may poorly affect their sense of satisfaction with care. Routine screening could identify families that need extra help. Our project is unique in that it incorporates routine screening for psychological stress into health maintenance visits, and has implications for clinical practice in general pediatrics.