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Improving Hospital-to-Home Transitions for Children Entering Foster Care

Michael DeLucia1, Anna Martens1, JoAnna Leyenaar2,3

  • 1School of Medicine, Tufts University, Boston, Massachusetts.

Hospital Pediatrics
|July 26, 2018
PubMed

Insights

Children discharged to new foster caregivers experienced lower quality hospital transitions. This included less checklist use and teach-back education, potentially increasing risks for these vulnerable pediatric patients.

Area of Science:

  • Pediatric healthcare quality
  • Patient safety
  • Healthcare transitions

Background:

  • Hospital-to-home transitions pose risks, particularly for children with new foster caregivers.
  • These children may face poorer discharge outcomes due to vulnerabilities during transition.
  • Understanding discharge quality differences is crucial for improving care for this population.

Purpose of the Study:

  • To compare discharge quality and outcomes for pediatric patients discharged to new foster caregivers versus those returning to preadmission caregivers.
  • To identify specific areas of disparity in discharge processes and patient outcomes.
  • To inform strategies for enhancing the safety and effectiveness of hospital-to-home transitions for vulnerable children.

Main Methods:

  • Retrospective cohort study of pediatric patients discharged between January 2014 and May 2017.
  • Comparison of patients discharged to new foster caregivers (index cases) with a matched cohort discharged to preadmission caregivers.
  • Evaluation of 5 discharge quality process measures and 2 discharge outcomes through chart review.

Main Results:

  • Patients discharged to new foster caregivers (56 index cases) showed worse performance on 4 of 5 process measures compared to matched patients (165).
  • Significantly lower use of discharge readiness checklists (75% vs. 92%) and teach-back education (63% vs. 79%) was observed in the index group.
  • The index group had double the odds of post-discharge misunderstandings, though this did not reach statistical significance (26% vs. 13%).

Conclusions:

  • Discharge quality measures were less consistently applied for children transitioning to new foster caregivers.
  • This disparity may contribute to increased patient morbidity, indicated by caregiver misunderstandings.
  • Enhanced identification and targeted interventions for these patients and their new caregivers are recommended to improve transition outcomes.
Abstract

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