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Role of Health and Chronic Illness in Inpatient Care Experiences

Jennifer W. Mack, MD, MPH; John Patrick T. Co, MD, MPH; Donald A. Goldmann, MD; Jane C. Weeks, MD, MSc; Paul D. Cleary, PhD

Arch Pediatr Adolesc Med. 2007;161(9):828-834.

Objective  To assess how parent reports about the inpatient care of their children vary according to the health status of children with and without chronic conditions.

Design  We analyzed parent responses to the Picker Institute Pediatric Inpatient Survey.

Setting  Thirty-nine hospitals between January 1, 1997, and December 31, 1999.

Participants  Overall, 12 562 parents of children who received inpatient care at participating hospitals.

Main Outcome Measure  Parent rating of overall quality of care.

Results  Fifty-one percent of parents reported that their child had a chronic condition. Quality-of-care ratings varied according to health status and the presence of chronic conditions. Parents of children in the worst (fair or poor) health without chronic conditions reported lower quality of care (P < .001) and more care problems (P < .001) than did those with chronic conditions. Parents of children in the best (excellent, very good, or good) health tended to rate care highly, whether or not their children had chronic conditions. In a multivariable model, the decrement in perceived quality of care associated with poorer health was greater for those without than for those with chronic conditions (P < .001).

Conclusions  Although children in poor health are at risk for experiencing a lower quality of health care, parents of such children who have chronic conditions report fewer care-related problems. This may be owing to the more frequent health care interactions and better continuity of care for children with chronic conditions.

Author Affiliations: Department of Medicine, Children's Hospital (Drs Mack and Goldmann), and Department of Pediatrics, Massachusetts General Hospital Center for Child and Adolescent Health Policy (Dr Co), and Departments of Pediatric Oncology (Dr Mack) and Adult Oncology (Dr Weeks) and the Center for Outcomes and Policy Research (Drs Mack and Weeks), Dana-Farber Cancer Institute, Boston, Massachusetts; and Institute for Healthcare Improvement (Dr Goldmann) and School of Public Health (Dr Cleary), Yale University, New Haven, Connecticut.

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