Results Summary

What was the research about?

When a child is leaving the hospital, hospital staff give parents instructions on how to take care of their child’s health at home. But once at home, many parents struggle with managing health problems that arise, including who and when to call for help.

In this study, the research team wanted to learn if giving parents extra support from a nurse after a child’s hospital stay decreased how often children returned to the hospital. The team compared usual care only with two ways of giving extra support:

  • Home visit. A nurse visited the parents’ home soon after their child’s hospital stay.
  • Phone calls. A nurse called the parents soon after their child’s hospital stay.

What were the results?

Within one month of going home from the hospital, children who had a nurse home visit returned to the hospital more often than children who had usual care only. The nurse phone call didn’t affect how many of the children returned to the hospital.

Compared with usual care only, neither the nurse visits nor the phone calls made a difference in

  • How parents coped with the stress of having their child home from the hospital
  • How long it took to get back to a normal routine

Two weeks after children went home, parents of children who had a nurse home visit or a nurse phone call remembered more health problem warning signs than those who had usual care only.

Who was in the study?

The nurse home visit study included 1,500 children. Of these, 61 percent were white, 29 percent were African American, and 6 percent were Hispanic. The average age of children was 2, and 52 percent were boys.

The nurse phone call study included 966 children. Of these, 64 percent were white, 23 percent were African American, and 4 percent were Hispanic. The average age was 2, and 52 percent were boys.

All children were going home from a children’s hospital in Ohio and had at least one parent who spoke English.

What did the research team do?

The research team assigned children in each study by chance to either receive extra support or usual care.

For children who had home visits, the visits took place within four days of going home from the hospital. Nurses checked to see if each child was getting better. The nurse gave the child’s parent a list of warning signs and told parents to seek medical care if their child had any of the signs.

For children who had phone calls, a nurse called parents at home two to four days after going home from the hospital. During the call, the nurse went over the same information as the home visits.

Usual care included directions for parents about getting their child follow-up medical care and providing any prescription medicines the child would be taking.

For both studies, the research team called parents 14 to 23 days after their children went home. The team asked about healthcare use and life at home.

Parents and home-visit nurses gave feedback to the research team throughout the two studies.

What were the limits of the study?

The studies took place at one children’s hospital and included only children with at least one parent who spoke English. Results may differ at other hospitals or for children whose parents don’t speak English.

Future research could look at other ways to support children and their parents after they leave the hospital.

How can people use the results?

Hospitals can use these results when considering ways to support children and families after they leave the hospital.

Final Research Report

View this project's final research report.

Journal Citations

Article Highlight: Families with children who were discharged from the hospital and received a one-time telephone call within four days from a nurse to address postdischarge issues needed urgent health care services within the first 30 days almost as often as families who did not receive a phone call, according to a report in JAMA Pediatrics. However, parents who received the phone call were able to remember more clinical warning signs within the first two weeks of discharge than other parents. The researchers also suggest that the phone call might enhance standard postdischarge information provided to parents. The study involved 966 children and adolescents under the age of 18.

Related Journal Citations

Stories and Videos

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • Reviewers asked for more information on how the researchers determined the outcomes of interest. The researchers explained they planned to examine the reutilization of urgent healthcare services as a primary outcome because of the current health policy climate. The qualitative work with families early in the study, along with literature review, identified additional outcomes of interest to families.
  • Reviewers noted that many of the pediatric patients in the study had common illnesses that tend to resolve on their own and do not require further treatment or follow-up. The researchers stated that this was by design because discharges from this population are the most prevalent from children’s hospitalizations. The researchers added text to expand on their rationale and provide additional information about the severity of illness in the children. They also responded to the reviewers that the severity of illness and prevalence of complex chronic conditions were well balanced between the intervention and control groups, reducing the possibility of bias related to these factors.

Conflict of Interest Disclosures

Project Information

Samir S. Shah, MD, MS
Cincinnati Children's Hospital Medical Center
$2,267,361
10.25302/04.2020.IHS.130600811
Improving Post-Discharge Outcomes by Facilitating Family-Centered Transitions from Hospital to Home -- The H2O Study

Key Dates

December 2013
December 2018
2013
2018

Study Registration Information

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Last updated: November 30, 2022