Socioeconomic status influences the toll paediatric hospitalisations take on families: a qualitative study

Abstract

Background Stress caused by hospitalisations and transition periods can place patients at a heightened risk for adverse health outcomes. Additionally, hospitalisations and transitions to home may be experienced in different ways by families with different resources and support systems. Such differences may perpetuate postdischarge disparities. Objective We sought to determine, qualitatively, how the hospitalisation and transition experiences differed among families of varying socioeconomic status (SES). Methods Focus groups and individual interviews were held with caregivers of children recently discharged from a children's hospital. Sessions were stratified based on SES, determined by the percentage of individuals living below the federal poverty level in the census tract or neighbourhood in which the family lived. An open-ended, semistructured question guide was developed to assess the family's experience. Responses were systematically compared across two SES strata (tract poverty rate of <15% or ≥15%). Results A total of 61 caregivers who were 87% female and 46% non-white participated; 56% resided in census tracts with ≥15% of residents living in poverty (ie, low SES). Interrelated logistical (eg, disruption in-home life, ability to adhere to discharge instructions), emotional (eg, overwhelming and exhausting nature of the experience) and financial (eg, cost of transportation and meals, missed work) themes were identified. These themes, which were seen as key to the hospitalisation and transition experiences, were emphasised and described in qualitatively different ways across SES strata. Conclusions Families of lower SES may experience challenges and stress from hospitalisations and transitions in different ways than those of higher SES. Care delivery models and discharge planning that account for such challenges could facilitate smoother transitions that prevent adverse events and reduce disparities in the postdischarge period. Trial registration number NCT02081846; Pre-results.

Lost Earnings and Nonmedical Expenses of Pediatric Hospitalizations

“…Our own qualitative work suggests that all medical and nonmedical costs related to hospitalizations can together stretch a family's economy, leading to challenges in prioritizing key postdischarge decisions (eg, to fill a prescribed medication or not, to follow-up with a primary care appointment or not). 2 Similar findings have been present in adult populations, particularly in geriatrics, in which socioeconomic vulnerability has been shown to complicate the transition and postdischarge periods. 3 -6 Nonmedical costs can be immediate and unexpected and are not covered by insurance.…”

“…Our previous focus groups with caregivers of children who were recently hospitalized highlighted the relevance of these hardships during this vulnerable period. 2,24 Families that are already at greater risk for undesirable posthospitalization outcomes 9, 10 on account of preexisting hardships also must confront the reality of losing more of their daily income than their more affluent peers. Having less income and/or more costs could lead families to have less to spend on posthospitalization needs; recommended treatments and follow-up visits could be delayed or missed.…”

“…We conducted a face-to-face in-hospital survey as part of H2O and collected information on the child's demographic characteristics, including age (<3, 3-10, or >10 years), race (white, African American, or other), and insurer (private or public or self-pay). 2,15 Parents selfreported their own sex, marital status (single, widowed, separated, divorced, or married or living with partner), educational attainment (less than a college degree or college or more), employment status, and work flexibility. We categorized the employment variable according to the number of parents who were employed (0, 1, or 2) and whether that employment was full-or parttime.…”

Patient safety in marginalised groups: a narrative scoping review

“…Over two thirds of studies (69%) concerned just four marginalised groups. The largest of these (constituting over a quarter of studies (26%)) focused on ethnic minority groups [8, 32, 33, 39, 43, 46, 56, 59, 61-63, 66, 74, 82, 84, 93, 94], those residing in care homes (18%) [29, 32, 36, 54, 65, 77-79, 81, 85, 86, 88], followed by frail elderly populations (15%) [34, 37, 38, 51-53, 68, 73, 75, 83, 91, 92, 95], and individuals of low socio-economic status (10%) [40,41,60,69,72,87,90].…”

Mapping Neighborhood Health Geomarkers To Clinical Care Decisions To Promote Equity In Child Health

“…Alternatively, it may represent a return to a place with risks that triggered the exacerbation. 1 A deeper understanding of this “place” could be a key addition to clinical care, identifying drivers of disparities that the US health care system seeks to eliminate.…”