Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma

Abstract

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-8^th 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.

Keywords:

• Asthma
• care coordination
• school-based asthma therapy
• patient navigator
• home visit

Acknowledgements

The authors would like to thank Dr. Janet Phoenix and the Breathe Easy Asthma Home Visiting Program for their support of this intervention. In addition, would like to thank the IMPACT DC Asthma clinic team for their support of the project.

Declaration of interest

The other authors have no conflicts of interest to disclose.

Financial disclosure statement

Dr. Teach has received funding from NIH and Uptodate. The remaining authors have no financial relationships relevant to this article to disclose.

Additional information

Funding

Dr. Parikh was supported by grant number K08HS024554 from the Agency for Healthcare Research and Quality.