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Pediatrics. 2018 Aug;142(2). pii: e20174278. doi: 10.1542/peds.2017-4278. Epub 2018 Jul 11.

Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial.

Author information

1
Departments of Pediatrics, School of Medicine and Public Health, and rcoller@pediatrics.wisc.edu.
2
Departments of Pediatrics, David Geffen School of Medicine and.
3
Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.
4
Children's Discovery and Innovation Institute, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California.
5
Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin.
6
Cedars-Sinai Medical Center, Los Angeles, California; and.
7
Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California.
8
RAND Health, RAND Corporation, Santa Monica, California.

Abstract

OBJECTIVES:

We sought to examine the effect of a caregiver coaching intervention, Plans for Action and Care Transitions (PACT), on hospital use among children with medical complexity (CMC) within a complex care medical home at an urban tertiary medical center.

METHODS:

PACT was an 18-month caregiver coaching intervention designed to influence key drivers of hospitalizations: (1) recognizing critical symptoms and conducting crisis plans and (2) supporting comprehensive hospital transitions. Usual care was within a complex care medical home. Primary outcomes included hospitalizations and 30-day readmissions. Secondary outcomes included total charges and mortality. Intervention effects were examined with bivariate and multivariate analyses.

RESULTS:

From December 2014 to September 2016, 147 English- and Spanish-speaking CMC <18 years old and their caregivers were randomly assigned to PACT (n = 77) or usual care (n = 70). Most patients were Hispanic, Spanish-speaking, and publicly insured. Although in unadjusted intent-to-treat analyses, only charges were significantly reduced, both hospitalizations and charges were lower in adjusted analyses. Hospitalization rates (per 100 child-years) were 81 for PACT vs 101 for usual care (adjusted incident rate ratio: 0.61 [95% confidence interval 0.38-0.97]). Adjusted mean charges per patient were $14 206 lower in PACT. There were 0 deaths in PACT vs 4 in usual care (log-rank P = .04).

CONCLUSIONS:

Among CMC within a complex care program, a health coaching intervention designed to identify, prevent, and manage patient-specific crises and postdischarge transitions appears to lower hospitalizations and charges. Future research should confirm findings in broader populations and care models.

PMID:
29997169
PMCID:
PMC6317544
[Available on 2019-08-01]
DOI:
10.1542/peds.2017-4278
[Indexed for MEDLINE]

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