Examining Factors Associated with Utilization of Chaplains in the Acute
Care Setting
Abstract
Objective: Patient-centered care prioritizes individual values, beliefs,
and needs. Neglecting aspects of patients’ needs often exacerbates
existing disparities. Patients want their spiritual needs addressed and
discussed with the healthcare team, but providers feel unprepared to do
so. While most patients want chaplaincy care, very few receive it, and
little is known about the factors that contribute to its use. Thus, we
aim to identify what population characteristics are associated with the
utilization of chaplaincy services. Data Sources: Electronic medical
record (EMR) data matched with Hospital Consumer Assessment of
Healthcare Providers and Systems (HCAHPS) survey data for
hospitalizations from March 2012 to July 2017. Design: With a
retrospective, cross-sectional analysis, hospitalizations for one
midwestern acute care hospital, were examined for use of spiritual care
services. The dependent variable examined was the amount of chaplaincy
care received. The study used variables categorized as predisposing
(age, sex, race, ethnicity, language, religious affiliation), enabling
(education), and need (self-reported health, self-reported mental
health, primary diagnosis, length of stay). Analysis controlled for
emergency department admission and date of hospitalization. Data
Collection: For each hospitalization, data from the EMR and HCAHPS data
were merged; analysis retained the first hospitalization for each
individual. Results: Bivariate analyses identified associations between
the receipt of chaplaincy care, predisposing variables, and need
variables. Bivariate analyses also yielded associations between the
amount of chaplaincy care and the same variables. Multivariate analysis
utilized a hurdle model that identified the consistent association
between need variables and receipt/use of chaplaincy care. Conclusions:
Regardless of predisposing or enabling characteristics, those with the
most acute health needs were more likely to receive chaplaincy care and
received more total care. Patient-centered models focused on whole
person care may need to evaluate strategic integration of spiritual care
and screening for spiritual needs beyond acute care responses.