Parent Experiences with Their Child's Hospitalization During COVID-19: A Canadian Study

ABSTRACT

Background: The COVID-19 pandemic has presented many challenges to healthcare systems and providers. The impacts upon healthcare service utilization have been examined, however, research which explores the potential impacts upon the experiences of parents of hospitalized children is scant. We sought to a) report on the experiences of parents of children who were hospitalized during the COVID-19 pandemic, and b) compare these with historical results, in a large Canadian province. Methods: A random sample of parents were surveyed within six weeks of their child's discharge from 14 hospitals (2 stand-alone pediatric, 12 adult). Surveys were administered using a modified version of the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) instrument and linked with administrative records. Discharges from April 2020 to February 2021 comprised the “during COVID-19” patient cohort, while those from April 2019 to February 2020 were the comparison (historical) cohort. These time periods were selected as they coincide with the introduction of COVID-related public health restrictions across our province. We examined 47 survey questions and reported unadjusted results as the percentage of “top box” responses to each question, determined by the most positive answer choice. Odds ratios and 95 percent confidence intervals for reporting a “top box” response among the “during COVID-19” cohort were calculated, while controlling for demographic and clinical features. Results: In total, 3,069 completed surveys (1,337 during COVID-19, 1,732 historical) were obtained. For the overall hospital rating, 70.3% of COVID-19 responses and 68.1% of historical responses were classified as “top box” (a rating of 9 or 10 out of 10). Taking the survey margin of error into account, the “during COVID-19” cohort had higher “top box” percentages on 12 of the questions examined, and lower ones on three. The remaining 32 questions showed no differences between the two time periods. In the adjusted regression analyses, the “during COVID-19” cohort had higher odds of “top box” ratings on two questions (confirming child's identity before giving medicine [aOR=1.38, 95%CI 1.17-1.64], overall rating of nurses [aOR=1.25, 95%CI 1.05-1.50]), and lower odds on two questions (staff reviewed vitamins, herbal medicines, and over the counter medicines on first day of hospital stay [aOR=0.75, 95%CI 0.64- 0.89], hospital had age-appropriate toys, books, mobiles and games [aOR=0.64, 95%CI 0.55-0.76]). Conclusion: Our study demonstrates that the experiences of parents of children who were hospitalized during the COVID-19 pandemic were comparable to historical results in our province. This highlights that despite the challenges imposed by the pandemic, the quality of hospital-based pediatric care remained intact. From a methodological perspective, the results also highlight the need for appropriate case-mix adjustments when comparing Child HCAHPS results from multiple cohorts.