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Determinants of Parent Satisfaction with Emergency or Urgent Care When the Patient Has Autism

Kirsch, Sarah F., BS*; Meryash, David L., MD*,†; González-Arévalo, Bárbara, PhD

Journal of Developmental & Behavioral Pediatrics: June 2018 - Volume 39 - Issue 5 - p 365–375
doi: 10.1097/DBP.0000000000000573
Original Articles
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Objective: The purpose of this study was to identify factors that predict parent satisfaction (PS) with their child with autism spectrum disorder (ASD)’s visit to a hospital emergency department (ED) or urgent care (UC) center.

Methods: Parents recruited through a national database whose child (3–21 years; N = 378) with ASD had been treated in an ED/UC center within the previous 3 years completed an anonymous on-line questionnaire. They answered questions about whether they were satisfied overall with the visit and the care provided, their demographics, patient characteristics, their expectations and preparation for the visit, and the ED/UC center experience itself, including their observations of staff interpersonal and communication skills (ICSs) and behaviors, and whether the patient was disruptive (D). Multiple correspondence analysis (MCA) was used to demonstrate the relative effects of individual variables on PS.

Results: Among the 10 most important determinants of PS with the visit were the 9 assessed staff ICS behaviors. These were followed by shorter than expected waiting time and the patient not being disruptive (ND) during the visit. PS was not associated with any of the 3 measures of patient disability severity (ASD subtype, communicative competence, or restrictiveness of educational placement), whether the patient is hyperreactive to sensory stimuli, reason for the visit, or parent's education.

Conclusion: PS with an ED/UC center visit when the patient has autism depends mostly on the quality of staff interactions with the patient and family. It is important for ED/UC center administrators to ensure that staff understand how to interact and communicate effectively with patients with ASD and their families.

*Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, NY;

Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY;

Division of Statistics, Northern Illinois University, DeKalb, IL.

Address for reprints: David L. Meryash, MD, Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Cohen Children's Medical Center of New York, 1983 Marcus Avenue, Suite 130 Lake Success, NY 11042; e-mail: dmeryash@northwell.edu.

Supported financially, in part, by Autism Speaks and conducted with the assistance of the Interactive Autism Network (IAN) at the Kennedy Krieger Institute, Baltimore, MD. IAN research is governed by the Johns Hopkins Medicine IRB (NA_00002750; PI: Paul H. Lipkin, MD).

S. F. Kirsch received a grant from Autism Speaks to conduct this research.

Disclosure: The authors declare no conflict of interest.

This study was approved, with exemption from full review, by the Northwell Institutional Review Board. A waiver of consent documentation was also granted.

See the Video Abstract at jdbp.org

Received July , 2017

Accepted March , 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.