Telehealth for Discharge Outcomes in Children

Study Overview
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Brief Summary
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This study will test the feasibility of a telehealth follow-up visit for patients and their caregivers who were recently discharged from a general pediatric inpatient unit.

Detailed Description
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Patient transitions from hospital to home have increasingly become recognized as a critical opportunity to promote patient safety and high quality care, both at University of California Davis Medical Center and nationwide. With over 16,000 children discharged from U.S. hospitals each day and a rate of 1 in 5 experiencing adverse events related to this process, it is estimated that hospital-to-home transition-related adverse events affect over 1.1 million children annually. The quality of hospital discharge also affects hospital readmission rates, length of hospital stay, and parental satisfaction. Discharge transition difficulties stem largely from care coordination failures throughout the hospital-to-home transition. The investigators recently conducted a qualitative study analyzing perspectives from parents and physicians of 20 children readmitted within 30 days of hospital discharge. The study identified a theme of caregivers having difficulty re-connecting to the child's medical team for ongoing care after discharge. When problems arose, caregivers reported challenges in knowing who to contact, when to reach out for help, and how to navigate the health system to prevent readmission. The advent of telehealth presents a unique opportunity to provide seamless follow-up for families following hospital discharge. Although telehealth has not previously been studied as a means of providing pediatric follow-up care after hospital discharge, similar methods of providing post-discharge hospital follow-up, including nurse- or physician-led phone calls and nurse home visits, were highly regarded by families, but failed to impact readmission rates. Telehealth provides a unique advantage over these alternate interventions by allowing face-to-face interaction via videoconference between the patient, caregiver, and hospital physician, who is already familiar with the patient's disease course and overall trajectory. At the investigators' site, although telehealth is readily available for use in most any clinical setting, it is not commonly used for hospital discharge follow-up. Therefore, this study proposes to test the feasibility of a telehealth follow-up visit for patients and their caregivers who were recently discharged from a general pediatric inpatient unit.

Official Title
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Telehealth for Discharge Outcomes in Children: A Feasibility Study

Conditions
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Pediatric Hospital Discharge, Telehealth

Intervention / Treatment
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* Behavioral: Telehealth follow-up


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Parents/legal guardians of patients recently discharged from the University of California Davis Children's Hospital pediatric hospitalist service, who were offered a telehealth follow-up visit following their child's discharge Pediatric hospitalists who discharged the above patients and offered a telehealth follow-up visit following discharge Exclusion Criteria: • Parents/legal guardians of children discharged from an intensive care or subspecialty service

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Telehealth<br>Patients/Caregivers who received a telehealth follow-up visit from a pediatric hospitalist following hospital discharge. | Behavioral: Telehealth follow-up<br>* A telehealth follow-up visit will be conducted via the Epic electronic medical record with a pediatric hospitalist following hospital discharge.<br>|
| Usual Care<br>Patients/Caregivers who did not receive a telehealth follow-up visit from a pediatric hospitalist following hospital discharge. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility Objective 1: Telehealth visit offered on hospital discharge | This objective will assess what percentage of patients discharged from the pediatric hospital medicine service were offered a telehealth follow-up visit on hospital discharge. | Within 7 days of hospital discharge | 
| Feasibility Objective 2: Parent agreement to engage in telehealth visit | This objective will assess what percentage of parents who were offered a telehealth visit following hospital discharge agreed to participate. | Within 7 days of hospital discharge | 
| Feasibility Objective 3: Successful completion of telehealth | This objective will assess what percentage of scheduled telehealth visits were successfully completed, as reported by the involved pediatric hospitalist. | Within 14 days of hospital discharge | 
| Feasibility Objective 4: Lack of technical issues | This objective will assess what percentage of scheduled telehealth visits had not technical issues, as reported by both the involved pediatric hospitalist and the involved caregiver. | Within 14 days of hospital discharge | 
| Feasibility Objective 5: Survey response rates | This objective will assess what percentage of surveys administered to both pediatric hospitalists and caregivers were completed. | Within 30 days of hospital discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital Readmission | This secondary outcome will assess 30-day hospital re-admission rates, by parental report. | Within 30 days of hospital discharge | 
| Hospital Length of Stay | This secondary outcome will assess hospital length of stay. This information will be extracted from the electronic medical record. | Within 7 days of hospital discharge | 
| 3-Item Care Transitions Measure | This secondary outcome will evaluate parent scores on the 3-item Care Transitions Measure, reflecting on their child's recent care transition from hospital to home. The 3-question survey include 4 answer choices from 1 (strongly disagree) to 4 (strongly agree), with higher scores indicated a better outcome. | Within 30 days of hospital discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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telehealth, hospital discharge, pediatric, telemedicine