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Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial
Ryan J Coller1, Thomas S Klitzner2, Carlos F Lerner2
1Departments of Pediatrics, School of Medicine and Public Health, and rcoller@pediatrics.wisc.edu.
Insights
A caregiver coaching intervention, Plans for Action and Care Transitions (PACT), reduced hospitalizations and healthcare charges for children with medical complexity. This intervention improved crisis management and care transitions, showing promising results for this vulnerable population.
Area of Science:
- Pediatric healthcare
- Complex care management
- Health coaching interventions
Background:
- Children with medical complexity (CMC) often experience high rates of hospitalization and associated healthcare costs.
- Effective interventions are needed to improve care transitions and reduce hospital utilization for CMC.
- Complex care medical homes aim to coordinate care for CMC but require enhanced support strategies.
Purpose of the Study:
- To evaluate the impact of the Plans for Action and Care Transitions (PACT) caregiver coaching intervention on hospital use among CMC.
- To assess PACT's effect on hospitalizations, readmissions, healthcare charges, and mortality.
- To determine the feasibility and effectiveness of a health coaching model within a complex care setting.
Main Methods:
- An 18-month randomized controlled trial comparing PACT to usual care in a tertiary medical center's complex care medical home.
- PACT focused on caregiver education for symptom recognition, crisis planning, and post-discharge transition support.
- Primary outcomes included hospitalizations and 30-day readmissions; secondary outcomes included total charges and mortality. Analyses used bivariate and multivariate methods.
Main Results:
- Adjusted analyses revealed significantly lower hospitalization rates (IRR: 0.61) and reduced mean patient charges ($14,206 lower) in the PACT group compared to usual care.
- While unadjusted analyses only showed reduced charges, adjusted models indicated a positive impact on hospitalizations.
- Mortality was significantly lower in the PACT group (0 deaths) compared to usual care (4 deaths, log-rank P = .04).
Conclusions:
- The PACT health coaching intervention demonstrates potential in reducing hospitalizations and healthcare charges for children with medical complexity.
- The intervention's focus on crisis management and care transitions appears effective within a complex care program.
- Further research is warranted to validate these findings in diverse populations and alternative care models.
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.
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