Improving Pediatric Patient-Centered Care Transitions (Impact): Outcomes for Technology-Supported Patients

The transition from hospital to home presents a safety risk to pediatric patients. Literature suggests the needs and outcomes of technology-supported patients (TSP) differ from other patients.

Objective:

To determine differences between TSP and non-TSP for Project IMPACT process measure implementation: teach-back education; discharge readiness checklist; inpatient to outpatient handoff; post discharge phone call and outcome measures: caregiver understanding of self-management skills after discharge and 30 day reutilization rates.

A multisite, observational time series to test a pediatric transition bundle in 4 medical centers using rational subgroup analysis to compare TSP to non-TSP. Data were collected via electronic health record review and post-discharge phone call interview. QI Charts© were used to create statistical process control charts. The API rules for detecting special cause variation were applied. Chi square was used to compare the two populations.

We enrolled 2629 patients; 361 were TSP. Two of four bundle elements were implemented less reliably for TSP: teach-back education (31% v 43%, p<0.0001) and post discharge phone call contact (46% v 54%, p=0.002). Caregiver understanding of self-management skills assessed on a post-discharge phone call was lower (27% v 43%, p<0.001), and more variable between sites for TSP (figure 1) and reutilization rates were markedly higher (25% v 7%, p<0.001). (figure 2)

In our pilot phase, the Project IMPACT transition bundle was less reliably implemented for TSP. Significant differences in outcome measures support that TSP are especially vulnerable during hospital-to-home transitions. Improving reliability of bundle implementation for TSP may improve outcomes. However, this population may also require enhanced efforts to safely

navigate hospital discharge.