The Effect of a Patient- and Family-Centered Care Curriculum on Pediatrics Residents' Patient-Centeredness

摘要

What was known A patient- and family-centered approach to care is important in enhancing quality, but little is known about the effectiveness of formal teaching approaches.;What is new Exposure to a patient- and family-centered curriculum did not increase pediatrics residents' self-perceived patient-centeredness. Residents showed a high degree of patient-centeredness before and after the intervention.;Limitations Single-site, single-specialty study limits generalizability; the pretest-posttest design did not guard against external factors that may influence results.;Bottom line Pediatrics residents perceived themselves as patient centered, with female residents scoring higher on the sharing dimension, and both sexes scoring equally on the caring dimension of patient-centeredness.;Introduction The Institute of Medicine's (IOM's) report Crossing the Quality Chasm1 included patient- and family-centered care (PFCC) as 1 of the 6 aims for improvement for the nation's health care system. The report challenged health care organizations to pursue these aims through system redesign, including innovative educational strategies to better prepare the health care workforce to participate in improvement and practice patient- and family-centered care. The American Academy of Pediatrics (AAP)2 also has emphasized the importance of PFCC, emphasizing an approach that encourages mutually beneficial collaboration among patients, families, and health care professionals. Despite the recommendations from the IOM and the AAP to increase the emphasis on PFCC and increasing efforts of medical schools to teach communication and professionalism, students may leave medical school more “doctor or disease centered” than when they enter.3 In contrast, there is a growing body of literature that describes improved outcomes with a patient- and family-centered approach to health care. Specifically, parental presence during procedures,4,5 parental involvement post procedure,6 and active involvement of child life specialists during hospitalization7 all have demonstrated important benefits for patients. Despite this evidence, there is no common road map for teaching these skills. To address this knowledge gap, the pediatrics residency program and family members on staff at Children's Mercy Hospitals and Clinics in Kansas City, Missouri, designed a PFCC curriculum.3;Methods Setting and Participants Children's Mercy Hospitals and Clinics is a free-standing children's hospital with a fully accredited pediatrics residency program. The study used a nonrandomized control group pretest-posttest quasi-experimental design. The experimental group consisted of the entire group of 24 categorical pediatrics interns beginning residency in 2009, and the control group consisted of all 22 categorical pediatrics residents graduating from residency that same year. Residents could opt out if they chose not to participate in the research study.;Results Twenty-four interns (100%) completed the precurriculum PPOS and 23 interns (100%) completed the postcurriculum PPOS. One intern transferred programs after the first year and the data were not included in any of the analyses. The experimental group included 17 women (74%) and 6 men (26%). The control group consisted of 17 of 22 graduating residents (78%) who completed the PPOS. This included 10 women (59%) and 7 men (41%) in the control group. The mean (±SD) total PPOS score for the experimental group before exposure to the curriculum was 4.6 (±0.43). The range of total PPOS scores was 3.7 to 5.6. Interns scored similarly in the sharing domain (mean of 4.6 [±0.52]) and the caring domain (mean of 4.7 [±0.4]). Female interns (4.8?±?0.36) were more patient centered than male interns (4.2?±?0.38) (P??=??.005) and scored significantly higher than the men (4.8?±?0.39 versus 4.0?±?0.46) in the sharing domain (P??=??.001). There was no difference in female and male interns in the caring domain (P??=??.11). The mean (±SD) total PPOS score for the