Quality of care at a children's hospital - The parents' perspective

Objectives: To develop a measure of parental perceptions of pediatric inpat ient quality of care, to identify processes of care that influence these pe rceptions, and to describe these perceptions of care. Design: An interdisciplinary team modified an existing measure of inpatient care for adults using focus groups and expert review. The resulting survey was administered by telephone. Setting: Tertiary care pediatric hospital. Patients: Trained telephone interviewers obtained reports from parents of c hildren discharged from the hospital during specified months. This report i s based on the answers to 122 questions provided by 3622 (77%) of 4724 pare nts who responded when surveyed from 1991 through 1995. Main Outcome Measures: Parents provided reports about specific clinical exp eriences, overall ratings of care, and patient demographic and illness char acteristics 2 weeks after patient discharge from the hospital. The analysis classified reports about pediatric care as either problems or not problems . Problems in different areas of care were averaged to create scores for th e dimensions. Results: Parents most often noted problems related to hospital discharge pl anning (18%) and pain management (18%) and less often reported problems con cerning communication about surgery (10%) or transmission of information to children (6%). Problems in communication between clinicians and parents co rrelated most strongly with overall quality ratings by parents (r = 0.59). Parents' specific reports of problems with care accounted for 42% of the va riation in their overall assessments of the inpatient care experience. Conclusions: Parental assessment of inpatient pediatric care rests heavily on the quality of communication between the clinician and parent. Specific processes of care strongly influence overall assessments. Such reports coul d be used to focus the quality-improvement activities of hospitals and incr ease the accountability of providers of care to children and families.