Kim Hoang

All Publications

• Improving Hospital-to-Home for Medically Complex Children: Views From Spanish-Speaking Caregivers. Hospital pediatrics Squires, S. S., Hoang, K., Grajales, L., Halpern-Felsher, B., Sanders, L. 2024

  Abstract

  Children with medical complexity (CMC) experience increased risk of adverse events during and after hospitalization, and these risks are even greater for CMC whose caregiver has a preferred language other than English. Because many adverse events for CMC may be attributable to communication challenges, understanding caregiver and physician perspectives may help prevent adverse events.We conducted semistructured interviews with Spanish-speaking caregivers of hospitalized CMC and their inpatient attending physicians. Each interview was conducted 24 to 72 hours after hospital discharge. Interviews continued until thematic sufficiency was reached. Interviews were audio recorded, transcribed, and translated verbatim. Investigators independently coded and reconciled codes using constant comparison to develop themes via inductive thematic analysis.We conducted 28 interviews (14 caregivers, 14 physicians). Three themes were identified: (1) barriers exist in providing language-concordant care in planning for transitions from hospital-to-home; (2) both physicians and caregivers perceived logistical challenges in using interpreters at the point of care; and (3) many caregivers felt uncomfortable asking physicians questions related to their child's medical management because of their language barrier. Participants also offered strategies to improve the transition from hospital to home: (1) empower families to ask questions and take notes, (2) consider the use of medical educators, and (3) improve the ability of hospital-based physicians to follow up with patients after discharge.Physicians strive for language-concordant care at each stage of discharge planning. However, unresolved gaps such as the lack of interpreter availability during medical-device education, require attention to promote safe transitions from hospital to home.

  View details for DOI 10.1542/hpeds.2024-007925

  View details for PubMedID 39410907

• Impact of Longitudinal Coaching on Pediatric Residents' Professional Identity Formation: A Multi-Institution Qualitative Study. Academic pediatrics Hoang, K., Mollie Grow, H., Rooholamini, S. N., McPhillips, H., Selling, S. K., Rassbach, C. E., Blankenburg, R. 2024

  Abstract

  OBJECTIVE: Coaching has emerged in medical education as a strategy for trainees' development and has been endorsed by the Coalition for Physician Accountability and American Medical Association. However, there is a lack of literature on how coaching impacts residents' professional identity formation (PIF). The purpose of this study was to explore how longitudinal clinical coaching impacted the professional identity of residency graduates.METHODS: In July to November 2020, we conducted an IRB-approved qualitative study with semi-structured interviews of residency graduates from two pediatric programs who participated in a longitudinal coaching program. We inductively analyzed the transcripts using thematic analysis, guided by the sensitizing principles of PIF. We did a member check to enhance trustworthiness.RESULTS: We interviewed 34 residency graduates from two institutions and identified four themes on how coaches influenced residency graduates' PIF by 1) a presence of a trusting relationship, 2) creating trust and sense of belonging through longitudinal encounters, supportive reflection, and formative feedback, 3) integrating clinical skill, career interests, and work-life integration, and 4) reflecting on their own personal and professional identities. Residency graduates highlighted coaching strategies that coaches, coaching programs, and residents themselves can take to promote resident PIF during residency.CONCLUSIONS: Residency coaches have the potential to influence residents' PIF through their longitudinal relationship grounded in trust. Coaching strategies can be used to enhance resident clinical and professional development during residency training.WHAT'S NEW: This study is the first to explore how clinical coaching can be used to develop and enhance residents' professional identity formation both during and after residency and provides strategies coaches and residents can use to facilitate PIF.

  View details for DOI 10.1016/j.acap.2024.04.012

  View details for PubMedID 38729301

• Leadership & professional development: Coaching to develop clinicians, teachers, and leaders. Journal of hospital medicine Hoang, K., Rassbach, C. E. 2023

  View details for DOI 10.1002/jhm.13150

  View details for PubMedID 37301729

• Concordance between electronic health record-recorded race/ethnicity and parental report in hospitalized children. Journal of hospital medicine Hoang, K., Gold, J., Powell, C., Lee, H. C., Floyd, B., Schroeder, A., Chadwick, W. 2023

  Abstract

  Electronic health records (EHRs) have become an important repository for patient race and ethnicity. Misclassification could negatively affect efforts to monitor and reduce health disparities and structural discrimination.We assessed the concordance of parental reports of race/ethnicity for their hospitalized children with EHR-documented demographics. We also aimed to describe parents' preferences on how race/ethnicity should be captured in the hospital's EHR.From December 2021 to May 2022, we conducted a single-center cross-sectional survey of parents of hospitalized children asking to describe their child's race/ethnicity and compared these responses to the race/ethnicity documented in the EHR.Concordance was analyzed with a kappa statistic (κ). Additionally, we queried respondents about their awareness of and preferences for race/ethnicity documentation.Of the 275 participants surveyed (79% response rate), there was 69% agreement (κ = 0.56) for race and 80% agreement (κ = 0.63) for ethnicity between parent report and EHR documentation. Sixty-eight parents (21%) felt that the designated categories poorly represent their child's race/ethnicity. Twenty-two (8%) were uncomfortable with their child's race/ethnicity being displayed on the hospital's EHR. Eighty-nine (32%) preferred a more comprehensive list of race/ethnicity categories.Nonconcordance between EHR-recorded race/ethnicity and parental report exists in the EHR for our hospitalized patients, which has implications for describing patient populations and for understanding racial and ethnic disparities. Current EHR categories may be limited in their ability to capture the complexity of these constructs. Future efforts should focus on ensuring that demographic information in the EHR is accurately collected and appropriately reflects families' preferences.

  View details for DOI 10.1002/jhm.13140

  View details for PubMedID 37226928

• The Effects of Coaching Pediatric Residents on Faculty Coaches' Relationships, Learning, and Professional Identity Formation. Academic medicine : journal of the Association of American Medical Colleges Selling, S. K., Rooholamini, S. N., Grow, H. M., McPhillips, H., Hoang, K., Blankenburg, R., Rassbach, C. 2022

  Abstract

  PURPOSE: Coaching programs have been implemented in medical education to improve skill development and feedback for trainees. As more faculty take on coaching roles, it is critical to understand how being a coach affects faculty as well as trainees. This study examined the effects of coaching residents on faculty members' relationships, learning, and professional identity formation (PIF), as they move through intersecting communities across landscapes of practice.METHOD: From July 2020 to January 2021, the authors conducted a mixed-methods study of current and former coaches at 2 institutions with longitudinal pediatric resident coaching programs. They used a concurrent triangulation design in which qualitative and quantitative data were collected simultaneously and integrated during data analysis. A survey explored the impact of coaching on faculty members' learning, relationships, and PIF, and semi-structured interviews further examined coaches' experiences. The interview transcripts were analyzed inductively guided by the sensitizing principles of PIF and landscapes of practice.RESULTS: Of 43 eligible coaches, 32 (74%) completed the survey, and 18 completed interviews. Four themes emerged from the interviews. (1) Coaches' relationships supported belonging in multiple communities. (2) Coaching enabled multidimensional learning. (3) Relationships served as mechanisms of learning for coaches. (4) Coaches' relationships and learning catalyzed PIF. Furthermore, there was a significant difference in the effects of coaching on career growth by faculty rank (P = .02). Coaches' strengthened PIF increased a sense of purpose, meaning, and professional fulfillment, and inspired new career directions. Survey data further supported these findings.CONCLUSIONS: Being a coach deepened faculty members' professional identities through their varied relationships, multidimensional learning, and sense of belonging in intersecting communities. This study introduces a framework to understand the factors mediating coaches' PIF and highlights how investing in coaching leads to important benefits for coaches.

  View details for DOI 10.1097/ACM.0000000000005011

  View details for PubMedID 36205486

• Fertility Benefits at Top U.S. Medical Schools. Journal of women's health (2002) Hoang, K., Evans, N., Aghajanova, L., Talib, H., Linos, E., Gold, J. M. 1800

  Abstract

  Background: Female physicians have a higher prevalence of infertility compared with the general population. Physician well-being can be significantly impacted by the physical and emotional challenges associated with this, including the high cost of fertility treatments, which are often not covered by health insurance. There are limited data on the current state of fertility coverage available for physicians. This study examines fertility insurance benefits offered for faculty at top U.S. medical schools. Methods: Between March and April 2021, we reviewed fertility benefits at medical schools ranked in the top 14 for research as identified by the US News & World Report 2021. The summary plan descriptions of benefits were collected from each institution's human resources (HR) website and direct phone call to HR representatives. We examined descriptions of coverage for fertility services including evaluation, treatments, medications, maximum lifetime coverage, and whether a formal diagnosis of infertility was required for benefit eligibility. Results: Fourteen institutions offer benefits for fertility evaluation and 13 offer benefits for treatment. Of the 13 institutions that offer treatment coverage, 11 cover in vitro fertilization, with 6 having limits on the number of cycles. Twelve offer medication coverage. Ten institutions specified maximum lifetime coverage for treatments and medications, ranging from $10,000 to $100,000. Only 1 school provided coverage for elective fertility preservation, and none covered surrogacy expenses. Half of the schools are in states where fertility benefits are mandated. Conclusion: There is wide variation in fertility benefits offered at top medical schools across the country. Many schools offered coverage for fertility evaluation and treatments; however, majority had restrictions and limitations to the benefits, suggesting that there is still inadequate coverage provided. This study's selected sample also does not reflect other medical schools across the country, which may not be as well-resourced in their provision of fertility benefits.

  View details for DOI 10.1089/jwh.2021.0486

  View details for PubMedID 35041526

• Improving Inpatient Consult Communication Through a Standardized Tool. Pediatrics Pavitt, S., McHugh, A., Chi, K., Hoang, K., Lippner, E., Tsai, J., Goldstein, R., Bassett, H., Srinivas, N. S. 2021

  Abstract

  OBJECTIVES: To increase the number of essential consult elements (ECEs) included in initial inpatient consultation requests between pediatric residents and fellows through implementation of a novel consult communication tool.METHODS: Literature review and previous needs assessment of pediatric residents and fellows were used to identify 4 specific ECEs. From February to June 2018, fellows audited verbal consult requests at a medium-sized, quaternary care children's hospital to determine the baseline percentage of ECE components within consults. A novel consult communication tool containing all ECEs was then developed by using a modified situation-background-assessment-recommendation (SBAR) format. The SBAR tool was implemented over 3 plan-do-study-act cycles. Adherence to SBAR, inclusion of ECEs, and consult question clarity were tracked via audits of consult requests. A pre- and postintervention survey of residents and fellows was used to examine perceived miscommunication and patient care errors and overall satisfaction.RESULTS: The median percentage of consults containing ≥3 ECEs increased from 50% preintervention to 100% postintervention with consult question clarity increasing from 52% to 92% (P < .001). Overall perception of consult miscommunication frequency decreased (52% vs 18%; P < .01), although there was no significant change in resident- or fellow-reported patient errors. SBAR maintained residents' already high consult satisfaction (96% vs 92%; P = .39) and increased fellows' consult satisfaction (51% vs 91%; P < .001).CONCLUSIONS: Implementation of a standardized consult communication tool resulted in increased inclusion of ECEs. Use of the tool led to greater consult question clarity, decreased perceived miscommunication, and improved overall consult satisfaction.

  View details for DOI 10.1542/peds.2020-0681

  View details for PubMedID 33858984

• Words Matter: An Antibias Workshop for Health Care Professionals to Reduce Stigmatizing Language. MedEdPORTAL : the journal of teaching and learning resources Raney, J., Pal, R., Lee, T., Saenz, S. R., Bhushan, D., Leahy, P., Johnson, C., Kapphahn, C., Gisondi, M. A., Hoang, K. 2021; 17: 11115

  Abstract

  Introduction: Biased language influences health care providers' perceptions of patients, impacts their clinical care, and prevents vulnerable populations from seeking treatment. Training clinicians to systematically replace biased verbal and written language is an essential step to providing equitable care.Methods: We designed and implemented an interactive workshop to teach health care professionals a framework to identify and replace stigmatizing language in clinical practice. The workshop included a reflective exercise, role-play, brief didactic session, and case-based discussion. We developed the program for a broad target audience of providers and initially delivered it at three academic conferences. We used descriptive statistics to analyze Likert-style items on course evaluations and identified themes in open-text responses.Results: A total of 66 participants completed course evaluations; most believed the workshop met its objectives (4.8 out of 5.0) and strongly agreed that they would apply skills learned (4.8). Participants planned to incorporate reflection into their verbal and written language. Potential barriers to applying course content included perceived difficulty in changing entrenched practice habits, burnout, and fatigue. Suggestions for improvement included more time for group discussions and strategies to teach skills to colleagues.Discussion: Participants found the course material highly engaging and relevant to their clinical practice. Learners left the workshop feeling motivated to engage in more mindful word choice and to share key concepts with their colleagues.

  View details for DOI 10.15766/mep_2374-8265.11115

  View details for PubMedID 33768147

• Addressing Goals of Parents of Hospitalized Children: A Qualitative Analysis of Parents' and Physicians' Perspectives ACADEMIC PEDIATRICS Hoang, K., Halpern-Felsher, B., Brooks, M., Blankenburg, R. 2021; 21 (2): 244–51

  View details for Web of Science ID 000625570700008

• Shared Decision-making With Parents of Hospitalized Children: A Qualitative Analysis of Parents' and Providers' Perspectives. Hospital pediatrics Hoang, K., Halpern-Felsher, B., Brooks, M., Blankenburg, R. 2020

  Abstract

  OBJECTIVES: Shared decision-making (SDM) is the pinnacle of patient-centered care and has been shown to improve health outcomes, especially for children with chronic medical conditions. However, parents perceive suboptimal involvement during hospitalization. The objective was to explore the perspectives of parents of hospitalized children and their hospital providers on facilitators and barriers to SDM in the hospital and identify strategies to increase SDM.METHODS: A qualitative study was conducted by using semistructured interviews with parents of hospitalized children with and without complex chronic conditions and their pediatric hospital medicine faculty. Parents and faculty were matched and individually interviewed on the same day. Two investigators iteratively coded transcripts and identified themes using modified grounded theory, with an additional author reviewing themes.RESULTS: Twenty-seven parents and 16 faculty participated in the interviews. Four themes emerged: (1) parents and providers value different components of SDM; (2) providers assume SDM is easier with parents of children with medical complexity; (3) factors related to providers, parents, patients, and family-centered rounds were identified as barriers to SDM; and (4) parents and providers identified strategies to facilitate SDM in the hospital.CONCLUSIONS: There is a discrepancy between parents' and providers' understanding of SDM, with parents most valuing their providers' ability to actively listen and explain the medical issue and options with them. There are many barriers that exist that make it difficult for both parties to participate. Several strategies related to family-centered rounds have been identified that can be implemented into clinical practice to mitigate these barriers.

  View details for DOI 10.1542/hpeds.2020-0075

  View details for PubMedID 33037030

• EDUCATION JOURNAL OF HOSPITAL MEDICINE Blankenberg, R., Hoang, K. 2020; 15: 118–19

  View details for Web of Science ID 000538159300054

• A Previously Healthy Adolescent With Acute Psychosis and Severe Hyperhidrosis. Pediatrics Rosenblatt, T. n., Ort, K. n., Shaw, R. n., Levy, R. J., Chen, C. n., Niemi, A. n., Hoang, K. n. 2020

  Abstract

  A previously healthy 15-year-old boy presented with 3 months of progressive psychosis, insomnia, back and groin pain, and hyperhidrosis. On examination, the patient was disheveled, agitated, and soaked with sweat, with systolic blood pressure in the 160s and heart rate in the 130s. Aside from occasional auditory and visual hallucinations, his neurologic examination was normal. The patient was admitted for an extensive workup, including MRI of the brain and spine and lumbar puncture, which were normal. Through collaboration with various pediatric specialists, including psychiatry and neurology, a rare diagnosis was ultimately unveiled.

  View details for DOI 10.1542/peds.2019-3786

  View details for PubMedID 32444380

• Teaching Conflict Resolution in Medicine: Lessons From Business, Diplomacy, and Theatre. MedEdPORTAL : the journal of teaching and learning resources Wolfe, A. D., Hoang, K. B., Denniston, S. F. 2018; 14: 10672

  Abstract

  Introduction: Disagreement and conflict are inevitable among members of clinical teams, as well as with patients and families during the course of medical care. Despite the importance of physicians needing to negotiate and resolve conflicts, best practices for teaching these skills have not been established in a clinical setting.Methods: We developed teaching tools based on a conflict resolution model from the business world, emphasizing team dynamics and employing a structured, hierarchical approach to conflict resolution that preserves interpersonal relationships. We employed lessons from diplomacy and improvisational theatre to underscore nonverbal cues that improve communication during conflict. We prepared instructions for teaching conflict management and conflict resolution styles, small-group negotiations, case-based clinical scenarios, personal reflection, and facilitated debrief. The tools are customizable based on audience and available instructional time.Results: We implemented this resource for over 2 years with 20 pediatric residents and over 150 educators and fellows at national meetings. Participants reported that the topic was timely and important and identified the conflict resolution hierarchy, attention to conflict resolution styles, use of case-based discussion, and focus on nonverbal communication as effective and valuable elements.Discussion: This resource has been refined over five cycles of presentation and feedback with learners and educators. Our participants identified themes of conflicts in clinical settings that informed the case scenarios presented here, including interdisciplinary conflicts, ethical conflicts, and conflicts among members of the educational hierarchy. These tools are designed to meet established national educational priorities related to communication and professionalism across the educational continuum.

  View details for PubMedID 30800872

• Implementation of a Prehospital Protocol Change For Asthmatic Children PREHOSPITAL EMERGENCY CARE Nassif, A., Ostermayer, D. G., Hoang, K. B., Claiborne, M. K., Camp, E. A., Shah, M. I. 2018; 22 (4): 457–65

  Abstract

  Respiratory distress due to asthma is a common reason for pediatric emergency medical services (EMS) transports. Timely initiation of asthma treatment, including glucocorticoids, improves hospital outcomes. The impact of EMS-administered glucocorticoids on hospital-based outcomes for pediatric asthma patients is unknown.The objective of this study was to evaluate the effect of an evidence-based pediatric EMS asthma protocol update, inclusive of oral glucocorticoid administration, on time to hospital discharge.This was a retrospective cohort study of children (2-18 years) with an acute asthma exacerbation transported by an urban EMS system to 10 emergency departments over 2 years. The investigators implemented an EMS protocol update one year into the study period requiring glucocorticoid administration for all patients, with the major change being inclusion of oral dexamethasone (0.6 mg/kg, max. dose = 10 mg). Protocol implementation included mandatory paramedic training. Data was abstracted from linked prehospital and hospital records. Continuous data were compared before and after the protocol change with the Mann-Whitney test, and categorical data were compared with the Pearson χ2 test.During the study period, 482 asthmatic children met inclusion criteria. After the protocol change, patients were more likely to receive a prehospital glucocorticoid (11% vs. 18%, p = 0.02). Median total hospital time after the protocol change decreased from 6.1 hours (95% CI: 5.4-6.8) to 4.5 hours (95% CI: 4.2-4.8), p < 0.001. Total care time, defined as time from ambulance arrival to hospital discharge, also decreased [6.6 hours (95% CI: 5.8-7.3) vs. 5.2 hours (95% CI: 4.8-5.6), p = 0.01]. Overall, patients were less likely to be admitted to the hospital (30% vs. 21%, p = 0.02) after the change. Those with more severe exacerbations were less likely to be admitted to a critical care unit (82% vs. 44%, p = 0.02) after the change, rather than an acute care floor.Prehospital protocol change for asthmatic children is associated with shorter total hospital and total care times. This protocol change was also associated with decreased hospitalization rates and less need for critical care in those hospitalized. Further study is necessary to determine if other factors also contributed.

  View details for DOI 10.1080/10903127.2017.1408727

  View details for Web of Science ID 000436977600009

  View details for PubMedID 29351496

• Pediatricians' Communication About Weight With Overweight Latino Children and Their Parents PEDIATRICS Turer, C. B., Montano, S., Lin, H., Hoang, K., Flores, G. 2014; 134 (5): 892–99

  Abstract

  To examine pediatrician weight-management communication with overweight Latino children and their parents and whether communication differs by pediatrician-patient language congruency.Mixed-methods analysis of video-recorded primary care visits with overweight 6- to 12-year-old children. Three independent reviewers used video/transcript data to identify American Academy of Pediatrics-recommended communication content and establish communication themes/subthemes. Language incongruence (LI) was defined as pediatrician limited Spanish proficiency combined with parent limited English proficiency (LEP). Bivariate analyses examined associations of LI with communication content/themes.The mean child age (N = 26) was 9.5 years old; 81% were obese. Sixty-two percent of parents had LEP. Twenty-seven percent of pediatricians were Spanish-proficient. An interpreter was used in 25% of LI visits. Major themes for how pediatricians communicate overweight included BMI, weight, obese, chubby, and no communication (which only occurred in LI visits). The pediatrician communicated child overweight in 81% of visits, a weight-management plan in 50%, a culturally relevant dietary recommendation in 42%, a recommendation for a follow-up visit in 65%, and nutrition referral in 50%. Growth charts were used in 62% of visits but significantly less often in LI (13%) versus language-congruent (83%) visits (P < .001).Many overweight Latino children do not receive direct communication of overweight, culturally sensitive dietary advice, or follow-up visits. LI is associated with a lower likelihood of growth chart use. During primary care visits with overweight Latino children, special attention should be paid to directly communicating child overweight, formulating culturally sensitive weight-management plans, and follow-up. With LEP families, vigilance is needed in providing a trained interpreter and using growth charts.

  View details for DOI 10.1542/peds.2014-1282

  View details for Web of Science ID 000344385900037

  View details for PubMedID 25311599

  View details for PubMedCentralID PMC4210795