Comparing Hospital to Home Transition Interventions for Children with Medical Complexity

Children with medical complexity are frequently hospitalized and commonly face difficulties when they are discharged from the hospital. Most of these children and their families have some sort of problem with medications or equipment once they return home from the hospital. What is particularly challenging is that family members who help sort out these problems struggle to know who to call—the hospital or their primary care provider. The hospital-based team is often difficult to reach, and the primary care provider may not know everything about the hospitalization and hence may be unable to answer questions or help solve problems.

In previous work, our team partnered with families of children with medical complexity to develop an intervention to help prevent these difficulties after hospitalization and address issues quickly when they occur. The Garnering Effective Telehealth 2 Help Optimize Multidisciplinary team Engagement (GET2HOME) intervention has 3 parts:

1) a pre-discharge telehealth huddle which allows families to speak with both the hospital team and their outpatient care team (physicians, home care nurses, pharmacists) before they leave the hospital,

2) a discharge task tracker which allows families in the hospital to know which tasks are completed and which tasks still need to be completed before discharge, and

3) a post-discharge telehealth huddle which allows families to reconnect with the hospital team and their outpatient care team a few days after discharge.

We have successfully put the GET2HOME intervention into routine care at our hospital. Families, physicians, nurses, and pharmacists rate the intervention positively. However, we do not know if and how the GET2HOME intervention changes outcomes for children with medical complexity. In this trial, children will be assigned at random (through essentially a coin toss) to receive the GET2HOME intervention or standard discharge care. We will compare outcomes after discharge between the two groups. We will compare how often children return to the emergency department or hospital within 30 days of discharge. We will compare family ratings of the discharge experience and if the GET2HOME intervention improved  discharge education or families’ knowledge of whom to contact with questions or concerns. We will compare both the quality of life and how long it takes to return to normal baseline status for the children and their families at 7, 30, 60, and 90 days after discharge.

Finally, we will see if children whose families have fewer financial resources at baseline (before hospitalization) may  experience the most benefit from the GET2HOME intervention. Our diverse, multidisciplinary team of researchers, families of children with complex chronic disease, doctors, and nurses will meet with an advisory board of general pediatricians, experts in children with complex chronic disease, experts in pediatric research, and representatives from insurance companies. We will use our advisory board’s broad expertise to help us spread the GET2HOME intervention to other hospitals if it is found to be superior to standard care.