L. C. Pruitt1, D. K. Cao1, D. E. Skarda1, B. T. Bucher1 1University Of Utah,Division Of Pediatric Surgery, Department Of Surgery, School Of Medicine,Salt Lake City, UT, USA
Introduction:
Little is known about what hospital factors families take into account when selecting a hospital where their child will undergo surgery. These decision-making processes are becoming increasingly important during the regionalization of pediatric surgical care. New technology including computerized process tracing allows us to explore this question in greater complexity.
Methods:
Using a cross-sectional study design, families were recruited from the pediatric surgery outpatient clinic at a single center. Both new consults and post-operative patient families were eligible, as were families of children of any age who had presented to the clinic. Non-English-speaking families were excluded. Using the computerized process tracing tool Mouselab WEB four hospital selection scenarios were developed around elective outpatient pediatric surgical procedures. Each scenario gave participants a choice between three hospitals; for each hospital three factors were given: travel time, in- or out-of-network for insurance, and presence of a fellowship-trained surgeon. The movement of the mouse was tracked allowing the study of what factors they looked at, as well as what they self-reported to be important. In addition to the computerized scenarios, each participant filled out a brief demographic questionnaire and the AHRQ REALM-SF to assess health literacy.
Results:
In this pilot study 24 families were recruited. Health literacy was high in our sample with 83% having a high school or above reading level. In our sample 67% had at least one child who had previously undergone surgery. A hospital was selected that had a fellowship trained surgeon present 89% of the time. Parents of a child of Latino/Hispanic ethnicity were less likely to select a hospital with a fellowship-trained surgeon (X2 (1, N=96)= 4.24, p = 0.04). A hospital was selected that was in-network for insurance 55% of the time. Families selected the hospital with the shortest travel time 67% of the time. Parents reported that the presence of a fellowship-trained surgeon was the most important hospital characteristic to them 58% of the time. In-or out-of-network for insurance was the most important for 42%. None of the families felt that travel time was the most important factor when selecting a hospital. There was no statistically significant difference in the percentage of time they spent looking at the three hospital factors.
Conclusion:
This pilot data shows the feasibility of using computerized process tracing tools in the setting of clinical research to better understand patient and family decision-making. All of the participants were able to use the computerized tools without difficulty and the resulting data gives an additional layer of complexity when compared to simple self-reported survey results. The pilot data suggests that patients are willing to travel further and potentially go to a hospital out-of-network in order to take their child to a center with a fellowship-trained surgeon.