Virtual Family-Centered Rounds: A Telehealth Innovation to Reduce Care Experience Disparities - PROJECT SUMMARY / ABSTRACT This project will reduce care experience disparities by increasing equitable access to family-centered rounds (FCR) for parents or guardians (“parents” hereafter). We focus on reducing disparities in parent FCR attendance, family-centered care, and patient safety outcomes for families of hospitalized children with a preferred language other than English (LOE), low income, and racial/ethnic minorities. We propose a cluster randomized trial of offering parents the option to use “virtual FCR” to (1) evaluate and compare the impact of this telehealth intervention between socially disadvantaged vs. advantaged subgroups and (2) understand factors affecting intervention implementation and impact. Our team has the skills required to conduct this research, with expertise in telehealth interventions, clinical trials, community engagement, culturally and linguistically appropriate healthcare, qualitative and mixed methods, patient safety measures, and statistics. Our team includes two advisory groups, one of which comprises parents with Spanish language preference. The focus of this project is FCR on pediatric units in a children’s hospital. FCR is best practice for hospitalized children. FCR benefits include fewer harmful errors, improved family understanding of the care plan, increased parental trust in providers, and shortened hospital stays. However, FCR is only possible if parents can be at the bedside during FCR. Importantly, circumstances that prevent parents from being physically in the hospital (e.g., financial, work, travel) disproportionately hinder under-resourced families, particularly rural and low- income families. Our preliminary research suggests that the option to use telehealth to conduct virtual FCR overcomes these problems and reduces FCR attendance disparities based on race/ ethnicity, education, and neighborhood health conditions. In this proposal, we build on our prior work to include parents with LOE and involve all pediatric units in a children’s hospital. Also, we enhanced our telehealth platform by integrating it with video interpreters, with feasibility testing showing good usability, fidelity, and reach. We pursue three Specific Aims: Evaluate and compare the impact of providing parents the option to participate in virtual FCR between socially disadvantaged vs. advantaged subgroups on parent FCR attendance (Aim 1) and parent experience, safety, and utilization (Aim 2). Conduct a mixed methods virtual FCR implementation evaluation (Aim 3). Our trial has sufficient power to detect modest heterogeneity of treatment effects for parent FCR attendance and family-centered care (co-primary outcomes) across different subgroups. We hypothesize that, for each comparison, the intervention effect will be greater for the socially disadvantaged group (LOE, low income, racial/ethnic minorities). By achieving these aims, we will advance a health information technology solution to reduce disparities in parent FCR attendance, care quality, healthcare safety outcomes, healthcare utilization, and parent activation. This project has potential to alter institutional norms for FCR by focusing on systemic inequities in the delivery of pediatric care that harm economically and socially marginalized groups.
