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

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.