Transitional Care for Pediatrics

(H2H-CYSHCN Trial)

This trial tests two support systems, known as Hospital-to-Home Transitional Care Interventions, to aid children with special health care needs in transitioning from hospital to home. The goal is to determine whether a short-term or long-term support plan more effectively reduces hospital visits and boosts parents' confidence in caring for their child. The study focuses on how these plans work for children with complex needs and aims to reduce health disparities among different racial and ethnic groups. Families who might be suitable have children under 18, have consulted multiple specialists in the past year, and will be returning home after their hospital stay. As an unphased trial, this study offers families the opportunity to contribute to important research that could enhance care transitions for children with special health care needs.

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

Research has shown that Hospital-to-Home Transitional Care Interventions (H2H-TCI) are generally safe and well-received by patients. Studies have found that these programs can reduce hospital readmissions, indicating improved patient health without harm. For instance, one study showed that a more intensive program reduced hospital readmissions from 42% to 29%, demonstrating effectiveness without introducing new risks.

Researchers are excited about the hospital-to-home transitional care interventions for pediatric patients because these approaches aim to smooth the transition from hospital to home, potentially reducing readmissions and improving overall health outcomes. Unlike traditional care, which often leaves gaps in communication and support once patients leave the hospital, these interventions offer continuous, personalized care during this critical period. The unique aspect here is the tailored support, which can include follow-up visits, phone check-ins, and coordination with community healthcare providers, ensuring a seamless and supportive transition for young patients and their families.

Research has shown that assisting families in transitioning from hospital to home can significantly reduce the likelihood of readmission for children with special health needs. This trial will compare two approaches: the Focused Dose Hospital-to-Home Transitional Care Interventions and the Extended Dose Hospital-to-Home Transitional Care Interventions. One study found that a more intensive support program reduced readmissions from 42% to 29% within three months. Another review highlighted that these programs also enhance care coordination, easing the transition for children with complex medical issues. These programs provide structured support and resources to families, boosting their confidence and decreasing the need for emergency care. The overall goal is to deliver personalized care tailored to each child's specific health needs.¹³⁵⁶⁷