The inpatient experience of emerging adults in the United States.

OBJECTIVES: Emerging adults transitioning from pediatric to adult care experience worse outcomes including increased mortality. Improved patient experience (PEX) correlates with decreased inpatient mortality and better adherence to quality guidelines. We aimed to evaluate trends in the PEX of inpatients aged 14-29 years in the United States (US). METHODS: We performed a retrospective cohort study using a national, de-identified PEX survey obtained from hospitalized patients aged 14-29 years between 2017 and 2019. We described and compared survey responses across 10 domains. Composite mean scores for each health facility were converted to percentile rankings, which were then compared by age group to determine differences in percentile ranking (ΔPR). RESULTS: We evaluated the results of 174,174 PEX surveys across a national sample of 1519 US hospitals. The PEX percentile rankings for ages 18-21 were lower than ages 14-17 in almost every domain including experience with nurses (ΔPR = 43.4, p < 0.001), physicians (ΔPR = 31.1, p < 0.001), treatment (ΔPR = 12.3, p < 0.001), and overall experience (ΔPR = 26.5, p < 0.001). Similarly, 22-25-year-olds reported a worse PEX across nearly all domains when compared to 26-29-year-olds. CONCLUSION: In a national sample of PEX surveys, hospitalized emerging adults aged 18-25 reported worse PEX when compared to both older children and established adults. These lower ratings were most strongly attributed to people, processes, and relationships as opposed to differences in the hospital environment. By ages 26-29, PEX returned to levels similar to those reported by ages 14-17. These results suggest that further investigation to elucidate the unique needs of hospitalized emerging adults may be warranted.

The Inpatient Experience of Emerging Adults: Transitioning From Pediatric to Adult Care.

The pediatric-to-adult care transition has been correlated with worse outcomes, including increased mortality. Emerging adults transitioning from child-specific healthcare facilities to adult hospitals encounter marked differences in environment, culture, and processes of care. Accordingly, emerging adults may experience care differently than other hospitalized adults. We performed a retrospective cohort study of patients admitted to a large urban safety net hospital and compared all domains of patient experience between patients in 3 cohorts: ages 18 to 21, 22 to 25, and 26 years and older. We found that patient experience for emerging adults aged 18 to 21, and, to a lesser extent, aged 22 to 25, was significantly and substantially worse as compared to adults aged 26 and older. The domains of worsened experience were widespread and profound, with a 38-percentile difference in overall experience between emerging adults and established adults. While emerging adults experienced care worse in nearly all domains measured, the greatest differences were found in those pertinent to relationships between patients and care providers, suggesting a substantial deficit in our understanding of the preferences and values of emerging adults.

Integrating Prevention of Mother-to-Child Transmission of HIV Care into General Maternal Child Health Care in Western Kenya.

BACKGROUND: Health systems integration is becoming increasingly important as the global health community transitions from acute, disease-specific health programming to models of care built for chronic diseases, primarily designed to strengthen public-sector health systems. In many countries across sub-Saharan Africa, including Kenya, prevention of mother-to-child transmission of HIV (pMTCT) services are being integrated into the general maternal child health (MCH) clinics. The objective of this study was to evaluate the benefits and challenges for integration of care within a developing health system, through the lens of an evaluative framework. METHODS: A framework adapted from the World Health Organization's six critical health systems functions was used to evaluate the integration of pMTCT services with general MCH clinics in western Kenya. Perspectives were collected from key stakeholders, including pMTCT and MCH program leadership and local health providers. The benefits and challenges of integration across each of the health system functions were evaluated to better understand this approach. RESULTS: Key informants in leadership positions and MCH staff shared similar perspectives regarding benefits and challenges of integration. Benefits of integration included convenience for families through streamlining of services and reduced HIV stigma. Concerns and challenges included confidentiality issues related to HIV status, particularly in the context of high-volume, crowded clinical spaces. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: The results from this study highlight areas that need to be addressed to maximize the effectiveness and clinical flow of the pMTCT-MCH integration model. The lessons learned from this integration may be applied to other settings in sub-Saharan Africa attempting to integrate HIV care into the broader public-sector health system.