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Randomized controlled trial evaluating a collaborative model of care for transitioning children with medical
Savithri Nageswaran1, Douglas Easterling2, Cobi W Ingram1
1Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Insights
This study tested the ICollab model to support home health nurses caring for children with medical complexity. The innovative care model aims to improve healthcare delivery and reduce hospital readmissions for these vulnerable children.
Area of Science:
- Pediatric Healthcare
- Nursing Care Models
- Health Services Research
Background:
- Children with medical complexity (CMC) require significant healthcare resources and frequent hospitalizations.
- Existing models for home healthcare delivery for CMC post-discharge are not well-tested.
- High-quality home health nursing (HHN) is crucial for managing CMC at home.
Purpose of the Study:
- To develop, implement, and evaluate the ICollab care model for improving home healthcare for CMC.
- To assess the impact of the ICollab model on healthcare utilization, caregiver burden, and satisfaction.
- To examine the effects of the ICollab model on HHN retention and interprofessional collaboration.
Main Methods:
- A randomized clinical trial involving 110 CMC discharged to home health nursing services.
- Intervention group (n=55) received the ICollab model for 6 months post-discharge, alongside usual care.
- Control group (n=55) received usual care. Outcome measures included healthcare utilization, caregiver outcomes, and HHN-related metrics.
Main Results:
- The study hypothesizes that the ICollab model will reduce healthcare utilization and caregiver burden.
- It is also hypothesized to improve caregiver satisfaction, HHN retention, and HHN collaboration.
- Results are pending as the study is ongoing.
Conclusions:
- The ICollab model has the potential to enhance home healthcare delivery for CMC.
- Evidence from this study could inform interventions to improve care quality for CMC.
- The findings may support improved outcomes for CMC and their families.
Abstract:
This article describes the study protocol for an evaluation of an innovative model of care that supports home health nurses (HHN) who serve children with medical complexity (CMC). CMC constitute a small proportion of children, but have very high need for health services, are hospitalized frequently, and account for significant proportion of pediatric healthcare expenditures. High-quality home health nursing services are important for CMC, but models of care of home healthcare, after discharge of CMC from the hospital, have not been tested. Our project aims are to develop, implement, and test a model of care, called ICollab, to improve home healthcare delivery for CMC. The ICollab model consists of collaboration between HHN, primary-care physicians and clinicians of the complex care program of a tertiary-care children's hospital in the care of CMC. In this randomized clinical trial, we will recruit 110 CMC discharged home on home health nursing services. The intervention group (n = 55) will receive the ICollab intervention for 6 months post-discharge from the hospital, in addition to usual care. Children in the control group (n = 55) will receive only usual care. Outcome measures will include healthcare utilization metrics (hospitalization rates, emergency room visit rates, and days to readmission), caregiver burden and caregiver satisfaction with home healthcare, HHN retention, and HHN collaboration with other healthcare providers. We hypothesize that ICollab will reduce healthcare utilization and caregiver burden, and improve caregiver satisfaction with home healthcare, increase HHN retention, and increase HHN collaboration with other healthcare providers. Results of this study have the potential to provide a critically needed evidence-base for interventions to improve the quality of healthcare delivery for CMC. This study is registered on clinicaltrials.gov (NCT03978468) and is ongoing.
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