601 - The association between shared decision-making and child health measures in the general pediatric population

Shared decision-making (SDM), a key component of patient-centered communication, aims to build collaborative relationships between patients and providers. Using SDM has shown promising results for improved health outcomes and decreased healthcare expenditure among children with special health care needs (CSHCN) and chronic diseases. However, much remains unknown about the role of SDM in the general pediatric population.

Objective: To describe the association between parent-reported SDM, child health status and healthcare utilization metrics in a national pediatric sample

Design/Methods: Using data from the National Survey of Children’s Health (NSCH) 2019, 2020 & 2021, children who needed medical decisions made in the 12 months prior to survey participation were included. Four outcomes were analyzed: child health status, forgone health care, missed school days due to illness or injury, and emergency room (ER) visits. The main independent variable, SDM, was dichotomized to present or absent SDM (Table 1). Bivariate and multivariable logistic regressions controlled for child age, CSHCN status, race/ethnicity, parental education, health insurance type, and household language. A p=0.05 indicated a statistically significant association.

Results: This analysis included 31,791 children. The majority (85%) experienced SDM. There were significant disparities in SDM across sociodemographic variables including race/ethnicity, parental education, and health insurance type (Table 2). In adjusted analysis (Table 3), parents reporting SDM had significantly greater odds of reporting excellent or very good child health status (adjusted odds ratio [aOR] = 1.49, 95% confidence interval [CI] 1.21-1.85) and lower odds of reporting more than 4 missed school days (aOR = 0.80, 95% CI 0.66-0.95). Experiencing SDM was associated with decreased odds of children forgoing needed health care (aOR = 0.22, 95% CI 0.17-0.27). SDM was not significantly associated with ER visits in the adjusted model.

Conclusion(s):

Use of SDM is associated with sociodemographic variables in the general pediatric population. When adjusting for sociodemographic variables, experience of SDM is associated with better child health, less forgone health care, and fewer missed school days due to illness. Using SDM to enhance collaborative communication represents a promising intervention to improve pediatric health and reduce disparities in outcomes.