Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
J Hosp Med. 2020 Sep;15(9):518-525. doi: 10.12788/jhm.3370.
The Hospital to Home Outcomes (H2O) trial was a 2-arm, randomized controlled trial that assessed the effects of a nurse home visit after a pediatric hospital discharge. Children randomized to the intervention had higher 30-day postdischarge reutilization rates compared with those with standard discharge. We sought to understand perspectives on why postdischarge home nurse visits resulted in higher reutilization rates and to elicit suggestions on how to improve future interventions.
We sought qualitative input using focus groups and interviews from stakeholder groups: parents, primary care physicians (PCP), hospital medicine physicians, and home care registered nurses (RNs). A multidisciplinary team coded and analyzed transcripts using an inductive, iterative approach.
Thirty-three parents participated in interviews. Three focus groups were completed with PCPs (n = 7), 2 with hospital medicine physicians (n = 12), and 2 with RNs (n = 10). Major themes in the explanation of increased reutilization included: appropriateness of patient reutilization; impact of red flags/warning sign instructions on family's reutilization decisions; hospital-affiliated RNs "directing traffic" back to hospital; and home visit RNs had a low threshold for escalating care. Major themes for improving design of the intervention included: need for improved postdischarge communication; individualizing home visits-one size does not fit all; and providing context and framing of red flags.
Stakeholders questioned whether hospital reutilization was appropriate and whether the intervention unintentionally directed patients back to the hospital. Future interventions could individualize the visit to specific needs or diagnoses, enhance postdischarge communication, and better connect patients and home nurses to primary care.
医院到家庭结局（H2O）试验是一项 2 臂、随机对照试验，评估了儿科出院后护士家访对患者的影响。与标准出院相比，接受干预的患儿在出院后 30 天内再利用率更高。我们试图了解为什么出院后家访会导致更高的再利用率，并征求有关如何改进未来干预措施的建议。
我们通过焦点小组和访谈，从利益相关者群体（家长、初级保健医生（PCP）、医院内科医生和家庭护理注册护士（RN））中寻求定性投入。一个多学科团队使用归纳、迭代方法对转录本进行编码和分析。
33 名家长参与了访谈。完成了 3 次 PCP 焦点小组（n = 7）、2 次医院内科医生焦点小组（n = 12）和 2 次 RN 焦点小组（n = 10）。增加再利用率的主要解释主题包括：患者再利用率的适宜性；危险信号/警告指示对家庭再利用决策的影响；医院附属 RN 指导患者回到医院；家访 RN 提高护理水平的门槛较低。改进干预设计的主要主题包括：需要改善出院后沟通；个性化家访——一刀切不适合所有人；以及提供危险信号的背景和框架。
利益相关者质疑医院再利用率是否合理，以及干预是否无意中将患者引导回医院。未来的干预措施可以根据特定需求或诊断进行个性化访问，加强出院后沟通，并更好地将患者和家庭护士与初级保健联系起来。
