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Implementation of a multidisciplinary discharge videoconference for children with medical complexity: a pilot study
Noga L Ravid1, Kayla Zamora2, Roberta Rehm3
11Department of Pediatrics, University of California, San Francisco, 550 16th St. 5th floor, Box 0110, San Francisco, CA 94143 USA.
Insights
A pilot study evaluated discharge videoconferences for children with medical complexity (CMC). While feasible and acceptable to participants, low adoption rates highlight the need to address recruitment and technical barriers for improved hospital-to-home transitions.
Area of Science:
- Health Services Research
- Pediatric Healthcare Delivery
- Telemedicine Implementation
Background:
- The transition from hospital to home for children with medical complexity (CMC) is challenging, often due to poor communication between hospitals and primary care providers (PCPs).
- Suboptimal communication can lead to fragmented care and adverse outcomes for CMC during this critical period.
Purpose of the Study:
- To evaluate the implementation of a novel discharge videoconference intervention.
- To assess the adoption, cost, acceptability, feasibility, and appropriateness of this intervention for CMC.
Main Methods:
- A pilot study employed mixed methods at a tertiary children's hospital.
- Discharge videoconferences were conducted for hospitalized children (<18 years) with complex chronic diseases (C-CD).
- Data collection included field notes, surveys, and interviews; analysis used descriptive statistics and thematic content analysis.
Main Results:
- Low adoption rate: 4 CMC (9%) participated in the videoconferences.
- Low time burden: Videoconferences averaged 5 minutes to schedule and 21.5 minutes in duration.
- High acceptability: Participants (hospitalists, caregivers, PCPs) found the videoconferences acceptable and appropriate, citing improved shared understanding, remote assessment, transparency, and increased PCP confidence.
Conclusions:
- The videoconference intervention shows promise for improving discharge communication for CMC.
- Low adoption suggests recruitment strategies and addressing feasibility barriers (internet quality, scheduling) are crucial for future implementation.
- This visual approach offers benefits but requires optimization for wider use in pediatric care transitions.
Background:
The hospital to home transition for children with medical complexity (CMC) poses many challenges, including suboptimal communication between the hospital and medical home. Our objective was to evaluate the implementation of a discharge videoconference incorporating the patient, caregiver, primary care provider (PCP), hospitalist physician, and case manager.
Methods:
We evaluated implementation of this pilot intervention at a freestanding tertiary care children's hospital using mixed methods. A discharge videoconference was conducted for hospitalized children (< 18 years old) meeting complex chronic disease (C-CD) criteria. We collected field notes and conducted surveys and semi-structured interviews. Outcomes included adoption, cost, acceptability, feasibility, and appropriateness. Adoption, cost, and acceptability were analyzed using descriptive statistics. Acceptability, feasibility, and appropriateness were summarized using thematic content analysis.
Results:
Adoption: A total of 4 CMC (9% of the 44 eligible children) had discharge videoconferences conducted. Cost (in provider time): On average, videoconferences took 5 min to schedule and lasted 21.5 min. Acceptability: All hospitalists involved (n = 4) were very likely to participate again. Interviews with caregivers (n = 4) and PCPs (n = 5) demonstrated that for those participating, videoconferences were acceptable and appropriate due to benefits including development of a shared understanding, remote physical assessment by the PCP, transparency, and humanization of the care handoff, and increased PCP comfort with care of CMC. Feasibility: Barriers included internet connection quality and scheduling constraints.
Conclusions:
This novel, visual approach to discharge communication for CMC had low adoption, possibly related to recruitment strategy. The videoconference posed low time burdens, and participating physicians and caregivers found them acceptable due to a variety of benefits. We identified several feasibility barriers that could be targeted in future implementation efforts.
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