Hospital to Home Outcomes

Study Overview
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Brief Summary
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Home Nurse Visit post discharge.

Detailed Description
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To identify barriers to successful transitions that are most meaningful to patients and families, and use these identified barriers to iteratively adapt an existing nurse home visit program to address these barriers. This study will also test the efficacy of a nurse home visit intervention in improving post-discharge outcomes through a randomized controlled trial.

Official Title
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Hospital to Home Outcomes (H2O): A Study to Improve the Fluidity of Transitions Between Hospital and Home

Conditions
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Focus: Hospitalized Patients

Intervention / Treatment
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* Other: Nurse Home Visit
* Other: Standard of Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient is under 18 years of age Patient is admitted to Cincinnati Children's Hospital Medical Center to hospital medicine, community pediatrics, adolescent medicine, neurology or neurosurgery. Exclusion Criteria: Patient to be discharged someplace other than home (e.g., residential facility, psychiatric facility) Patient's home residence is outside the home nursing service area Patient is eligible for traditional home nursing services Caregiver is non-English speaking

Ages Eligible for Study
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Maximum 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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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Home Nurse Visit<br>Families in this arm will receive a nurse home visit within 96 hours of discharge. | Other: Nurse Home Visit<br>* We will complete a single center, parallel, randomized, standard-of-care-controlled prospective study to determine the efficacy of a nurse home visit program, an intervention adapted from those studied in other populations (i.e., adults, high-risk infants) and re-engineered through Aim 2, in improving pediatric patient transitions from hospital to home<br>|
| Active Comparator: Control<br>This arm will receive standard of care. | Other: Standard of Care<br>* Control patients will be randomized to receive standard-of-care at discharge. This care at our institution includes pediatric hospitalist to PCP (primary care physician) verbal and written communication prior to discharge, written documentation for the family regarding prescribed medication regimen, recommended follow-up with outpatient PCP and relevant consultant(s), and delivery of prescribed medications from the hospital pharmacy to the patient's bedside.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Any Occurrence of Unplanned Re-hospitalization and/or Any Emergency/Urgent Care Visits Within 30 Days of Hospital Discharge | The dependent variable will be a dichotomized indicator of any occurrence of unplanned rehospitalization and/or any emergency department/urgent care visit within 30-days post-discharge (i.e. unplanned reutilization). Differences in this outcome between intervention and control groups will be evaluated using logistic regression with the stratification variables (neighborhood poverty and complex versus noncomplex teams) included in the model. | 30 days post-discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post Discharge Coping Difficulty Scale | Post-Discharge Difficulty Coping Scale (Weiss, et. al) measured at 14 day post-discharge phone call. Post-Discharge Coping Difficulty Scale uses an 11 point scaling format (0-10) with total scores ranging from 0 to 100. Higher scores represent greater coping difficulty. | 14 days post-discharge | 
| Days Until Normalcy | Number of days until normalcy: measured at post discharge phone call. Parents asked to recall the number of days it took to return to a 'normal' routine including the return to work and school (with option of not yet be back to normal). | 14 days post-discharge | 
| Red Flags Remembered | This was measured at the 14 day post-discharge phone call survey. Parents were asked to recall any red flags or warning signs to indicate the child's condition was getting worse. The number of red flags recalled could range from 0-10 depending on the template used. The template was a home visit guideline for nurses to use that was specific to the child's illness. For example, if the child had bronchiolitis the nurse would use the template bronchiolitis/croup/pneumonia to guide them through the visit. Higher values (i.e., the greater number of red flags remembered) represent a better outcome. | 14 days post-discharge | 
| Number of Participants With Occurrence(s) of an Unplanned Readmission Within 30 Days Post-discharge | Occurrence(s) of an unplanned readmission within 30 days post-discharge. | 30 days | 
| Number of Participants With Occurrence(s) of an Emergency Department Visit Within 30 Days Post-discharge | Occurrence(s) of an ED visit within 30 days post-discharge | 30 days | 
| Number of Participants With Occurrence(s) of 14-day Unplanned Healthcare Utilization | Occurrence(s) of 14-day unplanned healthcare utilization defined by unplanned re-hospitalization and/or any emergency/urgent care visit within 14 days or parent report of an unplanned visit to one of these places. Parent report is collected at the 14 day follow-up phone call. | 14 days post-discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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transitions of care, reutilization, home nurse visit, focus groups, quality improvement