Integrative Wellness Sessions In A Pediatric Hospital Setting: A Feasibility Study to Assess Evaluation of the Hospital Heroes Program at Banner's Diamond Children's Hospital
BACKGROUND: Evidence suggests complementary and alternative medicine (CAM) therapies can be effective in treating certain chronic, recurrent, and incurable conditions. Use of CAM in pediatric populations is increasing considerably and uptake is especially evident among hospitalized children. Further, burnout among healthcare providers is increasing, affecting both their wellbeing and patient outcomes. At Banner Children's Diamond Children's Hospital, patients, families, and staff can receive CAM through the Integrative Touch for Kids™ (ITK) Hospital Heroes (HH) program. SIGNIFICANCE: Further study to evaluate HH is vital to understanding the quality of care delivered and recommendations for improvement. OBJECTIVES: Assess feasibility of evaluation of HH by Aim 1: Describing the vision and programmatic structure of the HH program. Aim 2: Achieving therapist consensus on referral, care coordination, and debriefing processes; Aim 3: Evaluating session impact on pain, fear/distress/anxiety, global/overall well-being, and satisfaction. Describe retrospective case studies to highlight valuable outcomes otherwise not represented. FRAMEWORKS & METHODS: The Centers for Disease Control & Prevention Framework for Program Evaluation in Public Health, elements from the Ethnographic Assessment of Evaluation Systems, and elements from Donabedian's Quality Framework were used to create a novel, theory-based, whole practice, program evaluation framework to evaluate HH via the following aims. Aim 1: Structure- Key- informant ethnographic interviews with ITK management (N=2) and self-completed questionnaires by HH therapists (N=4) were used to describe the program vision and structural elements. Interviews were transcribed and all data was de-identified, described, and summarized. Transcripts were converted into culturally-appropriate word clouds validated by participants. Univariate and descriptive statistics were used to assess questionnaire items related to human resources and quality rankings were assigned based on ITK standards. Aim 2: Process- The Delphi method was used by administering self-administered ethnographic questionnaires (N=3) to all HH therapists (N=4) to generate consensus on referrals, care coordination, and debriefing processes. Concept Maps were created for each element and validated by participants. Aim 3: Outcomes- Evaluation instruments were developed and piloted in collaboration with ITK stakeholders and data was collected over a two-month period representing nearly 50% of sessions administered by the HH therapists, from Aims 1 and 2, for 2017. Session and recipient characteristics for all sessions (N=95), regardless of recipient ability to report, were summarized. Pre/post changes were calculated using validated scales for pain, fear/distress/anxiety, global/ overall well-being, and likelihood to recommend the hospital. Session satisfaction rankings were collected post-session. Wilcoxon matched-pair signed-rank tests were done to calculate significant differences between median changes pre/post session for recipients able to respond and stratified by recipient type. Retrospective case studies (N=4) were described from data in the electronic health record and/or ITK records, as well as interviews with HH therapists. RESULTS: The program structure was described and quality of human resources met or exceeded criteria for most indicators of quality. Expert consensus on therapist interactions related to referrals, care-coordination, and debriefing was achieved. Evaluation of the HH program was determined feasible and in alignment with the program model and short-term vision. Strong evidence to support decreases in pain and fear/distress/anxiety, as well as increases in global overall well-being were observed in recipients able to report. High levels of satisfaction (mean≥9.0) and top-box rankings for likelihood to recommend the hospital overall, were reported. Retrospective case studies (N=4) highlighted additional outcomes from multiple perspectives. CONCLUSION: These results help to support ethnographic evaluation of the HH program, a holistic and integrative model of care, as ITK continues expanding and replicating the HH program within and beyond the current setting. Knowledge reported provides a new theory-based, whole practice, program evaluation model and expands existing evidence on CAM use in hospitalized pediatric patients.
hospital, integrative medicine, pediatric, program evaluation, wellness, whole practice
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