Division of Hospital Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Center for Translational Research, Children's National Research Institute, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
J Asthma. 2021 Oct;58(10):1384-1394. doi: 10.1080/02770903.2020.1795877. Epub 2020 Aug 4.
To evaluate a multi-component hospital-to-home (H2H) transition program for children hospitalized with an asthma exacerbation.
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 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.
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.
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.
评估一项针对因哮喘加重而住院的儿童的多部分医院到家庭（H2H）过渡计划。
一项针对基于指南的哮喘护理的试点前瞻性随机临床试验，包括接受医疗补助的 K-8 年级儿童住院治疗哮喘加重的情况下，有无以患者为中心的多部分 H2H 计划。H2H 计划包括 5 个部分：出院时手头的药物、针对控制器药物的学校哮喘治疗（SBAT）、家庭触发因素评估的转诊、与初级保健提供者（PCP）的沟通以及患者导航员支持。主要结局包括可行性和可接受性。次要结局包括医疗保健利用、哮喘发病率和照顾者生活质量。
共纳入并随机分配了 32 名儿童。干预组的可行性结果包括：出院时手头有药物（100%）；开始使用控制器药物的 SBAT（100%）；完成了家访转诊（100%），并在出院后 4 周内完成了家访（44%）；与 PCP 进行了沟通（100%）；在第 3 天（81.3%）和第 14 天（46.7%）与患者导航员进行了沟通。干预组的可接受性结果包括：87.5%的家庭继续进行 SBAT，87.5%的家庭表示家访转诊非常有帮助。调整基线时年龄、哮喘严重程度和控制程度的差异后，医疗保健利用结果无显著差异。
这些初步数据表明，在住院期间启动的综合护理协调是可行且可接受的。有理由进行更大规模的试验，以确定该干预措施是否可以减少城市少数民族哮喘儿童的医疗保健利用。
