Article: Ju A, Sedano S, Mackin K, Koh J, Lakshmanan A, Wu S. Variation in Family Involvement on Rounds Between English-Speaking and Spanish-Speaking Families. Hosp Pediatr. 2022;12(2):132-142. doi:10.1542/hpeds.2021-006221
Fellow: Betsy Oddo, MD; Medical University of South Carolina
Summary: Family centered rounds (FCR) have become standard of care in pediatric hospital medicine, yet previous studies focused on Spanish-speaking families’ experiences with FCR have shown decreased levels of engagement and empowerment. Using a cross-sectional observational study approach, the authors aimed to describe variation in FCR practices for Spanish-speaking versus English-speaking families. Observational audits of FCR on the resident general pediatric teams, the resident subspecialty teams, and the hospitalist-only/hospitalist comanagement teams occurred from June 2019 to March 2020. It was found that fewer Spanish-speaking families were included in the medical team’s discussion on rounds (64.7% vs 76.3%, P = .017), were asked about questions at the start of rounds (44.4% vs 56.3%, P = .025), or were involved in discussion of discharge criteria (72.2% vs 82.8%, P = .018) when compared to English-speaking families. These differences were more pronounced on the resident general pediatric and subspecialist teams compared to the hospitalist-only/hospitalist comanagement teams. In a multivariable logistic regression analysis, it was found that Spanish-speaking families were less likely to be involved on rounds after controlling for team type and patient age (OR, 0.56; 95% CI, 0.34–0.90).
Key Strengths: This study included a large sample size (394 families, 261 English-speaking and 133 Spanish- speaking) with robust data collection methods. While previous studies have focused on the perspectives of Spanish-speaking families’ on FCR, this study directly observed differences in provider behaviors based on primary language.
Limitations/Flaws: An E-value sensitivity analysis of the data was performed and revealed moderate confounding, which indicates that unobservable factors may be affecting the study results. In addition, the examiners were only able to observe differences in FCR practice for families that were present and “actively engaged” on rounds. Spanish-speaking families may be experiencing disproportionate social or financial circumstances that would make it difficult to be present on rounds, thus skewing the results of the study.
Takeaway Message: Spanish-speaking families were less likely to be involved on FCR compared to English-speaking families, with significant variability based on team type. These findings build on existing literature demonstrating significant health disparities among Spanish-speaking families during hospitalization.
Practice Impact: Families should be included as an integral part of the rounding dialogue regardless of their primary language to ensure equitable care and prevent negative downstream consequences. Further investigation is needed to determine underlying factors associated with this variation in practice and to inform interventions to reduce inequity.
Fellow: Betsy Oddo, MD; Medical University of South Carolina
Summary: Family centered rounds (FCR) have become standard of care in pediatric hospital medicine, yet previous studies focused on Spanish-speaking families’ experiences with FCR have shown decreased levels of engagement and empowerment. Using a cross-sectional observational study approach, the authors aimed to describe variation in FCR practices for Spanish-speaking versus English-speaking families. Observational audits of FCR on the resident general pediatric teams, the resident subspecialty teams, and the hospitalist-only/hospitalist comanagement teams occurred from June 2019 to March 2020. It was found that fewer Spanish-speaking families were included in the medical team’s discussion on rounds (64.7% vs 76.3%, P = .017), were asked about questions at the start of rounds (44.4% vs 56.3%, P = .025), or were involved in discussion of discharge criteria (72.2% vs 82.8%, P = .018) when compared to English-speaking families. These differences were more pronounced on the resident general pediatric and subspecialist teams compared to the hospitalist-only/hospitalist comanagement teams. In a multivariable logistic regression analysis, it was found that Spanish-speaking families were less likely to be involved on rounds after controlling for team type and patient age (OR, 0.56; 95% CI, 0.34–0.90).
Key Strengths: This study included a large sample size (394 families, 261 English-speaking and 133 Spanish- speaking) with robust data collection methods. While previous studies have focused on the perspectives of Spanish-speaking families’ on FCR, this study directly observed differences in provider behaviors based on primary language.
Limitations/Flaws: An E-value sensitivity analysis of the data was performed and revealed moderate confounding, which indicates that unobservable factors may be affecting the study results. In addition, the examiners were only able to observe differences in FCR practice for families that were present and “actively engaged” on rounds. Spanish-speaking families may be experiencing disproportionate social or financial circumstances that would make it difficult to be present on rounds, thus skewing the results of the study.
Takeaway Message: Spanish-speaking families were less likely to be involved on FCR compared to English-speaking families, with significant variability based on team type. These findings build on existing literature demonstrating significant health disparities among Spanish-speaking families during hospitalization.
Practice Impact: Families should be included as an integral part of the rounding dialogue regardless of their primary language to ensure equitable care and prevent negative downstream consequences. Further investigation is needed to determine underlying factors associated with this variation in practice and to inform interventions to reduce inequity.