P2.P304: What Matters Most to Children: Improving Patient-Centered Care in the Pediatric Population

Purpose/Objectives: “What Matters Most” (WMM) refers to the core values, preferences, and priorities of an individual regarding their healthcare experience. While there is data on the impact of shared decision making in the medical care of adults, there is limited data in the pediatric population. We aim to increase the percentage of pediatric hospital medicine patient encounters in which patients and/or caregivers are asked “What Matters Most” from 8% to 75% in 5 months (July 2024) and study how this correlates with patient satisfaction.

Design/Methods: Following engagement of appropriate stakeholders including child life specialists, nursing staff, advanced practice providers, pediatric residents, and pediatric hospitalists, WMM was assessed for verbal patients >3 years and patients’ caregivers within the first 24 hours of admission. Responses were collected and recorded in the electronic medical record (EMR) storyboard using a combination of free-text and anticipated pre-populated responses. Using the Model for Improvement, this process was optimized through a series of PDSA cycles including stakeholder training, addition of smart phrases to the resident H&P template, scripts providing guidance asking WMM, and reminders in patient handoffs. Measures include the percentage of patients and caregivers asked WMM during admission (process), patient satisfaction and perception of patient-centered care (outcome), and staff perception of additional time spent on WMM, worthwhileness, satisfaction with the process, enhancement in care, alignment with care (balancing).

Results: We evaluated 3488 encounters: 2,519 during the baseline period from 10/1/2023 to 2/10/2024 and 969 post-intervention from 2/11/2024 to 4/5/2024. Four months of pre-intervention WMM implementation data for pediatric admissions showed a baseline median of 8% of patients/caregivers asked WMM. This value has increased to a median of 57% after 8 weeks of project implementation. For encounters with a WMM response (n=481), 62% (n=301) included caregiver responses, 19% (n=91) included patient responses, and 33% (n=162) were undifferentiated. There were no differences (p >0.05) in which patients were asked WMM based on race, ethnicity, language, gender, or age group. Outcome measures to date demonstrate that 100% (n=9) of parents strongly agree that their child’s care was personalized to their needs. Resident surveys (n=15, 38% of all residents) demonstrate that this question added < 2 minutes to their workflow for the majority (n=9, 60%); 33% (n=5) of qualitative resident responses identified question phrasing as a barrier to asking WMM.

Conclusion/Discussion: Project interventions have effectively increased the percentage of patients/caregivers asked WMM without a significant increase in provider workload. With further PDSA cycles and process optimization, we anticipate reaching our goal of 75% WMM implementation by July 2024. Future PDSA cycles will modify scripting for addressing WMM with patients and caregivers. Additional steps include analysis of meaningfulness/change in patient care and effect on patient length of stay.