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The Critical Illness Recovery for ChiLdrEn (CIRCLE) Program: Single-Center Multidisciplinary Model of Care, 2021-2023
Jessica M Jarvis1, Sarah Rubin2, Katie Hayden Joy3
1Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA.
Insights
The Critical Illness Recovery for ChiLdrEn (CIRCLE) program improved hospitalization experiences for most families. New functional impairments and healthcare utilization highlight the need for coordinated pediatric intensive care unit (PICU) follow-up care.
Area of Science:
- Pediatric critical care medicine
- Quality improvement initiatives
- Child health outcomes
Background:
- Pediatric intensive care unit (PICU) survivors face long-term challenges.
- A need exists for structured, longitudinal support programs post-PICU discharge.
- The Critical Illness Recovery for ChiLdrEn (CIRCLE) program was developed to address these gaps.
Purpose of the Study:
- To develop and evaluate the CIRCLE personalized program, a novel care model.
- To assess the impact of the CIRCLE program on child and family outcomes.
- To identify areas for improvement in post-PICU care coordination.
Main Methods:
- A single-center quality improvement initiative was conducted.
- The study involved 98 families of children admitted to a 36-bed PICU.
- Longitudinal multidisciplinary support was provided from PICU admission through 1-3 months post-discharge clinic follow-up.
Main Results:
- Most responding families (17/18) reported improved hospitalization experiences with the CIRCLE program.
- 63% of children had new functional impairments at follow-up.
- 29% of survivors experienced hospital readmission within 6 months.
Conclusions:
- The CIRCLE program demonstrated high family satisfaction.
- Opportunities for enhancing follow-up processes and outcome monitoring were identified.
- Findings underscore the necessity of coordinated PICU follow-up care for pediatric critical illness survivors due to persistent functional impairments and healthcare utilization.
Objectives:
To report the development and evaluation of the Critical Illness Recovery for ChiLdrEn (CIRCLE) personalized program, which is a new model of care to improve child and family outcomes.
Design:
Single-center quality improvement initiative.
Setting:
A 36-bed PICU and outpatient multidisciplinary clinic.
Patients:
During September 2021-June 2023, we recruited English-speaking families/caregivers of children younger than 18 years who were admitted to the PICU with new acquired brain injury, need for extracorporeal membrane oxygenation, or acute respiratory distress syndrome requiring invasive mechanical ventilation for 48 hours or more.
Interventions:
Families received multidisciplinary longitudinal support, including education, outcome monitoring, resources, and referrals, from PICU admission through to clinic follow-up 1-3 months post-discharge.
Measurements And Main Results:
The primary outcome was program satisfaction. Secondary outcomes were clinic attendance, caregiver measure completion, new functional impairments at follow-up, identified by caregiver-reported outcomes or electronic health record (EHR)-derived Functional Status Scale score, and healthcare utilization abstracted from the EHR. Ninety-eight families participated; 63 of 96 survivors (66%) were offered clinic follow-up and 51 of 63 (81%) attended. Of 18 responding caregivers, 17 reported that CIRCLE improved their hospitalization experience and 16 reported that CIRCLE provided value for their family. Measure completion ranged from 66 of 98 at baseline to 25 of 96 at follow-up. Eighty-eight families had complete functional outcomes data, 55 of 88 (63%) had 1 or more new functional impairment. Eighty-one of 96 survivors (84%) had 1 or more specialty follow-up appointment scheduled with a median (interquartile range) of 2 (1-3) specialties. Twenty-eight of 96 survivors (29%) had hospital readmission within 6 months.
Conclusions:
The CIRCLE personalized program was satisfied the majority of responding families. Opportunities to improve follow-up and outcome monitoring were identified. Frequency of new functional impairments and healthcare utilization support the need for coordinated PICU follow-up care.
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