Hospital-to-Home Transitional Care Interventions (H2H-TCI) Children/Youth With Special Health Care Needs (CYSHCN)

Launched by DUKE UNIVERSITY · May 20, 2024

Keywords

ClinConnect Summary

The Hospital-to-Home Transitional Care Interventions (H2H-TCI) study is looking at how different types of support can help children and youth with special health care needs (CYSHCN) when they leave the hospital. Specifically, the trial compares two approaches: a focused dose intervention, which provides short-term support, and an extended dose intervention, which offers more prolonged assistance. The goal is to see which method helps families better manage their child’s care at home and increases parents' confidence in handling their child's health needs. The study also aims to understand how these interventions work for different groups of children, especially those who might face extra challenges.

To participate in this study, children must be under 18, have had outpatient visits with two or more specialists in the year before their hospital stay, and be discharged to their home after hospitalization. Parents or caregivers need to be at least 18 years old and able to provide consent. Participants can expect to receive tailored support as they transition from the hospital to home, and their experiences will help improve care for other families in the future. It’s important to note that the study is not yet recruiting participants.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• * For this study, eligible children/youth with special health care needs (CYSHCN) and adult parent/caregiver dyads will be those who meet the following inclusion criteria:
• • 1. Child is a CYSHCN, defined as having seen two or more distinct specialty areas for outpatient visits during the 12 months prior to index hospitalization admission date
• • 2. Age of hospitalized child is under 18 years old
• • 3. Child hospitalized on a general pediatrics inpatient service line at participating site
• • 4. Adult parent/caregiver for the child is 18 years or older
• Exclusion Criteria:
• * Child exclusion criteria:
• • 1. Child will be discharged to any location besides home (e.g., long-term care or residential facility, skilled nursing facility, inpatient acute rehabilitation, psychiatric facility)
• • 2. Child is a ward of the state or has an ongoing social services investigation
• • 3. Child is already receiving transitional care, intensive longitudinal care coordination (e.g., organ/disease-specific clinical program, clinical division within the same institution as the hospital \[e.g., Children's Complex Care Program at UNC; Complex Care Service at Duke\]), and/or longitudinal population health care coordination as part of a bundled alternative payment care model.
• * Parent/caregiver exclusion criteria include:
• • 1. Age less than 18 years old
• • 2. Diminished capacity to provide consent/participate
• • 3. Primary language for parent/caregiver is any language besides English or Spanish