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Importance and Feasibility of Transitional Care for Children With Medical Complexity: Results of a Multistakeholder
JoAnna K Leyenaar1, Paul A Rizzo2, Dmitry Khodyakov3
1Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston, Mass.
Insights
Parents and healthcare professionals identified key interventions for improving hospital-to-home transitions for children with medical complexity (CMC). These findings can enhance transitional care programs for CMC.
Area of Science:
- Pediatrics
- Healthcare Management
- Patient Outcomes
Background:
- Children with medical complexity (CMC) face significant challenges during hospital-to-home transitions, leading to high healthcare utilization and adverse outcomes.
- Existing transitional care models for CMC have gaps, necessitating research into effective interventions.
- Understanding the perspectives of parents and healthcare professionals is crucial for developing patient-centered transitional care.
Purpose of the Study:
- To identify important and feasible hospital-to-home transitional care interventions for CMC.
- To gather consensus from parents of CMC and healthcare professionals on optimal transitional care strategies.
Main Methods:
- A 2-round electronic Delphi process involving 29 parents of CMC and 37 healthcare professionals.
- Panelists rated the importance and feasibility of 39 interventions using a 9-point Likert scale.
- Agreement was determined using RAND/UCLA Appropriateness Methods, with subsequent rounds refining interventions.
Main Results:
- A high response rate of 75% was achieved, with both panels endorsing most interventions as important.
- Healthcare professionals were more conservative than parents regarding the feasibility of certain interventions.
- Twenty-five interventions were deemed important and feasible, focusing on family engagement, care coordination, social support, predischarge education, and written materials.
Conclusions:
- Parents and healthcare professionals agree on the importance and feasibility of specific transitional care interventions for CMC.
- These identified interventions can inform the development and improvement of hospital transitional care programs and policies.
- The findings support a collaborative approach to enhance care transitions for children with medical complexity.
Background:
Children with medical complexity (CMC) account for disproportionate hospital utilization and adverse outcomes after discharge, and several gaps exist regarding the quality of hospital to home transitional care for this population. We conducted an expert elicitation process to identify important and feasible hospital to home transitional care interventions for CMC from the perspectives of parents and health care professionals.
Methods:
We conducted a 2-round electronic Delphi process to identify important and feasible transitional care interventions. Panelists included parents of CMC and multidisciplinary health care professionals. In the first round, panelists rated the importance and feasibility of 39 transitional care interventions on a 9-point Likert scale; agreement between panelists was defined according to RAND/UCLA Appropriateness Methods. The second round of data collection evaluated 16 interventions that panelists did not agree on in the first round and 8 new or revised interventions, accompanied by quantitative and qualitative data summaries.
Results:
A total of 29 parents of CMC and 37 health care professionals participated in the Delphi process (response rate 75%). Both stakeholder panels endorsed most interventions as important; health care professionals were less likely to rate several interventions as feasible compared with the parent panel. Over 2 rounds of data collection, the 2 stakeholder panels endorsed 25 interventions as important as well as feasible. These interventions related to family engagement during the hospitalization, care coordination and social support assessment, predischarge education, and written materials.
Conclusions:
Parents and health care professionals considered several transitional care interventions important as well as feasible. This research might inform hospitals' transitional care programs and policies.
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