286 - Epistemic Trust between Parents and Pediatric Clinicians: Association of Family-Centered Care with Healthcare Utilization, Health, and Resilience in Children with and without Special Healthcare Needs

Poster Number: 286
Publication Number: 286.407

Michael Arenson, UMass Chan Medical School, Worcester, MA, United States; Anne Fuller, McMaster University, Hamilton, ON, Canada; Julia Zelinsky, Boston University School of Public Health, Hatboro, PA, United States; Elizabeth Peacock-Chambers, Baystate Children's Hospital, Springfield, MA, United States; Yorghos Tripodis, Boston University School of Public Health, Boston, MA, United States; Heather Forkey, UMass Chan Medical School, Worcester, MA, United States; Arvin Garg, UMass Chan Medical School/UMass Memorial Health, Worcester, MA, United States

Background: Family-Centered Care (FCC) is a collaborative healthcare approach grounded in mutually beneficial partnerships among healthcare professionals, patients, and families. FCC facilitates the development of epistemic trust (i.e., the ability to trust appropriately in cultural sources of new knowledge) in the pediatric clinician, which may benefit families, especially those with children with special healthcare needs (CSHCN).

Objective: We examined whether FCC is associated with beneficial healthcare utilization, health, and resilience in children with and without special healthcare needs (N-CSHCN).

Design/Methods: This was a secondary analysis of the combined 2019-2020 National Survey of Children's Health. We included children with a personal doctor or nurse (PDN) to study families that had an opportunity to receive FCC in the past year. Our primary exposure was FCC, defined according to the NSCH codebook. Our outcomes represented healthcare utilization, child health, and resilience. We used multivariable logistic regression to measure associations between FCC and outcomes, controlling for sociodemographic characteristics, and using CSHCN as a moderator.

Results: Of 49,006 children with a PDN, 89.2% received FCC and 22.8% were CSHCN. In bivariate analysis, CSHCN were less likely than N-CSHCN to receive FCC (86.5% vs. 89.9%, p< 0001; OR: 0.72 [95% CI: 0.62, 0.83]). In multivariable logistic regression, FCC was significantly associated with never going to the ER (aOR: 0.71 [95% CI: 0.66-0.76), "excellent/very good" child health according to parental assessment (aOR: 1.29 [95% CI: 1.15-1.45), flourishing (0-5 years aOR: 1.89 [95% CI: 1.40, 2.54] and 6-17 years aOR: 1.49 [95% CI: 1.22, 1.82]) and having a resilient family (aOR: 1.83 [95% CI: 1.53, 2.20]). FCC had no meaningful outcome differences for CSHCN except for “excellent/very good” parental assessment of their child's health (N-CSHCN = aOR: 2.44 [95% CI: 1.54, 3.86] vs. CSHCN = aOR: 1.60 [95% CI: 1.20, 2.13]).

Conclusion(s): FCC was associated with beneficial healthcare utilization patterns, better parental assessment of child health, child flourishing, and family resilience for all children. However, CSHCN were less likely to receive FCC. CSHCN did not attenuate any association between FCC and outcomes except for “excellent/very good” parental assessment of their child’s health. These findings support recent guidance from the AAP regarding relational health and begin a conversation in pediatrics around the potentially critical role epistemic trust may play in pediatrics and healthcare delivery.