Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma.
OBJECTIVE
To evaluate a multi-component hospital-to-home (H2H) transition program for children hospitalized with an asthma exacerbation.


METHODS
A pilot prospective randomized clinical trial of guideline-based asthma care with and without a patient-centered multi-component H2H program among children enrolled in K-8th grade on Medicaid hospitalized for an asthma exacerbation. H2H program includes 5 components: medications in-hand at discharge, school-based asthma therapy (SBAT) for controller medications, referral for home trigger assessments, communication with the primary care provider (PCP), and patient navigator support. Primary outcomes included feasibility and acceptability. Secondary outcomes included healthcare utilization, asthma morbidity, and caregiver quality of life.


RESULTS
A total of 32 children were enrolled and randomized. Feasibility outcomes in the intervention group included: medications in-hand at discharge (100%); SBAT for controller medication initiated (100%); home visit referrals made (100%) and home visits completed within 4 weeks of discharge (44%); PCP communication (100%); patient navigator communication at 3 days (81.3%) and 14 days (46.7%). Acceptability outcomes in the intervention group included: 87.5% of families continued SBAT, and 87.5% of families reported it was extremely helpful to have the home visit referral. Adjusting for baseline differences in age, asthma severity and control, there was no significant difference in healthcare utilization outcomes.


CONCLUSION
These pilot data suggest that comprehensive care coordination initiated during the inpatient stay is feasible and acceptable. A larger trial is justified to determine if the intervention may reduce healthcare utilization for urban, minority children with asthma.
['Parikh|Kavita|K|0000-0003-0622-1691', 'Richmond|Miller|M|', 'Lee|Michael|M|', 'Fu|Linda|L|0000-0002-5649-5167', 'McCarter|Robert|R|0000-0002-7911-6078', 'Hinds|Pamela|P|0000-0001-6491-6649', 'Teach|Stephen J|SJ|0000-0001-9870-6519']
D018927:Anti-Asthmatic Agents D001249:Asthma D017028:Caregivers D002648:Child D002675:Child, Preschool D003142:Communication D003266:Continuity of Patient Care D005260:Female D006296:Health Services D006760:Hospitalization D006792:House Calls D006801:Humans D008297:Male D008484:Medicaid D010342:Patient Acceptance of Health Care D010351:Patient Discharge D062526:Patient Navigation D017410:Practice Guidelines as Topic D011446:Prospective Studies D011788:Quality of Life D012720:Severity of Illness Index D014481:United States
Asthma school-based asthma therapy patient navigator home visit care coordination