Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial

Abstract

<p class="first" id="d6985456e271">Hospital use and charges were reduced by a caregiver coaching intervention used to support care of patient crises and discharge transitions. </p><div class="section"> <a class="named-anchor" id="s01"> <!-- named anchor --> </a> <h5 class="section-title" id="d6985456e275">OBJECTIVES:</h5> <p id="d6985456e277">We sought to examine the effect of a caregiver coaching intervention, Plans for Action and Care Transitions (PACT), on hospital use among children with medical complexity (CMC) within a complex care medical home at an urban tertiary medical center. </p> </div><div class="section"> <a class="named-anchor" id="s02"> <!-- named anchor --> </a> <h5 class="section-title" id="d6985456e280">METHODS:</h5> <p id="d6985456e282">PACT was an 18-month caregiver coaching intervention designed to influence key drivers of hospitalizations: (1) recognizing critical symptoms and conducting crisis plans and (2) supporting comprehensive hospital transitions. Usual care was within a complex care medical home. Primary outcomes included hospitalizations and 30-day readmissions. Secondary outcomes included total charges and mortality. Intervention effects were examined with bivariate and multivariate analyses. </p> </div><div class="section"> <a class="named-anchor" id="s03"> <!-- named anchor --> </a> <h5 class="section-title" id="d6985456e285">RESULTS:</h5> <p id="d6985456e287">From December 2014 to September 2016, 147 English- and Spanish-speaking CMC &lt;18 years old and their caregivers were randomly assigned to PACT ( <i>n</i> = 77) or usual care ( <i>n</i> = 70). Most patients were Hispanic, Spanish-speaking, and publicly insured. Although in unadjusted intent-to-treat analyses, only charges were significantly reduced, both hospitalizations and charges were lower in adjusted analyses. Hospitalization rates (per 100 child-years) were 81 for PACT vs 101 for usual care (adjusted incident rate ratio: 0.61 [95% confidence interval 0.38–0.97]). Adjusted mean charges per patient were $14 206 lower in PACT. There were 0 deaths in PACT vs 4 in usual care (log-rank <i>P</i> = .04). </p> </div><div class="section"> <a class="named-anchor" id="s04"> <!-- named anchor --> </a> <h5 class="section-title" id="d6985456e299">CONCLUSIONS:</h5> <p id="d6985456e301">Among CMC within a complex care program, a health coaching intervention designed to identify, prevent, and manage patient-specific crises and postdischarge transitions appears to lower hospitalizations and charges. Future research should confirm findings in broader populations and care models. </p> </div>