Identifying parent preferences for care during a child’s admission to hospital: a discrete choice experiment

Introduction and aims: Currently, hospital managements have limited evidence of parental priorities for informing quality improvement projects and ensuring that these align with parent and carer priorities. Parent and carer surveys identify issues with care received during a child’s admission but rarely ask about relative preferences for care. Our aim was to measure which elements of care parents prioritised when their child is in hospital using a discrete choice experiment (DCE). Methods: Clinician and parent focus groups identified the elements of hospital care for inclusion: (1) safety, in terms of medication error rates; (2) accountability, reflected in the frequency of medication chart reviews; (3) disclosure of medication errors; (4) access to non-urgent care; (5) privacy and ward layout; (6) facility access through parking cost and availability; and (7) discharge predictability. We used a D-efficient unlabelled design using 20 choice sets blocked and randomised into two versions. Parents/carers of children (n = 382) were recruited on-line and onsite at two paediatric hospitals in NSW, Australia. Mixed logit models were estimated and observed preference heterogeneity was explored. Results: All attributes apart from parking significantly (p ≤ 0.05) impacted parent care choices. The most important attribute was for medication error rates (30% of total relative attribute importance), followed by disclosure of medication errors (21%), timely access to non-urgent routine care (13%) and frequency of medication reviews (13%). Ward layout and predictability of discharge both had a relative importance score of 11%, with parking the least important at 2%. Conclusions: Parents clearly prioritised patient safety over other care factors and the results can be used to inform policy and quality improvement projects that focus on what matters most to patients and their families.