274 Improving early life pediatric surgical care: Designing and implementing a multi-methods assessment of disparities and opportunities for intervention in pediatric inguinal hernia repair (PIHR)

Objectives/Goals: Pediatric inguinal hernia (PIH) is a common diagnosis managed by pediatric surgeons. Patients typically present in the outpatient setting for evaluation. However, a subset present emergently with hernia incarceration, which has a higher risks. Our research aims to identify and address disparities in access to care of PIHR. Methods/Study Population: This study has a sequential multi-methods approach. First, we will perform a retrospective cohort study of pediatric patients (ages 0–18) who have undergone PIHR at St Louis Children’s Hospital (SLCH) over the past 5 years (n = 3,421). We will assess the impact of demographic and system-based factors on patient outcomes. Second, we will conduct interviews with caregivers of patients who have undergone PIHR. Qualitative interviews will be coded to prospectively identify themes in barriers and facilitators to accessing care, understanding of disease, and effectiveness of risk factor education by the pediatric care team. Finally, we will analyze the readability index (RI) of patient provided materials to assess the impact of health literacy on access to care and PIHR outcomes. Results/Anticipated Results: We hypothesize that demographic factors and socioeconomic status (SES) impact outcomes in PIHR. We anticipate higher rates of incarceration and emergent presentation of children from low SES and racial/ethnic racial minorities in our dataset, with longer time from initial presentation to definitive repair. Moreover, we anticipate identifying significant barriers to accessing care for non-white patients and patients with low SES, with gaps in understanding about the risk factors, presentation, and management of PIH. Finally, we hypothesize that the RI of our patient provided materials do not match community literacy rates, and there will be opportunities to implement new patient provided materials to improve parental education and communication in the perinatal space. Discussion/Significance of Impact: More than 600 patients undergo PIHR annually at a large tertiary care pediatric hospital, with those who are born premature being at higher risk. Using a mixed-methods approach, we aim to implement targeted interventions to facilitate access to care and improve patient outcomes in PIHR.