Improving Hospital-to-Home Transitions for Children Entering Foster Care

Author:

DeLucia Michael1,Martens Anna1,Leyenaar JoAnna23,Mallory Leah A.4

Affiliation:

1. School of Medicine, Tufts University, Boston, Massachusetts;

2. Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire;

3. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; and

4. Department of Pediatrics, The Barbara Bush Children’s Hospital, Maine Medical Center, Portland, Maine

Abstract

BACKGROUND AND OBJECTIVES: Hospital-to-home transitions present safety risks for patients. Children discharged with new foster caregivers may be especially vulnerable to poor discharge outcomes. With this study, our objective is to identify differences in discharge quality and outcomes for children discharged from the hospital with new foster caregivers compared with children discharged to their preadmission caregivers. METHODS: Pediatric patients discharged from the Barbara Bush Children’s Hospital at Maine Medical Center between January 2014 and May 2017 were eligible for inclusion in this retrospective cohort study. Chart review identified patients discharged with new foster caregivers. These patients were compared with a matched cohort of patients discharged with preadmission caregivers for 5 discharge quality process measures and 2 discharge outcomes. RESULTS: Fifty-six index cases and 165 matched patients were identified. Index cases had worse performance on 4 of 5 discharge process measures, with significantly lower use of discharge readiness checklists (75% vs 92%; P = .004) and teach-back education of discharge instructions for caregivers (63% vs 79%; P = .02). Index cases had twice the odds of misunderstandings needing clarification at the postdischarge call; this difference was not statistically significant (26% vs 13%; P = .07). CONCLUSIONS: Hospital-to-home transition quality measures were less often implemented for children discharged with new foster caregivers than for the cohort of patients discharged with preadmission caregivers. This may lead to increased morbidity, as suggested by more frequent caregiver misunderstandings. Better prospective identification of these patients and enhanced transition improvement efforts targeted at their new caregivers may be warranted.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics,General Medicine,Pediatrics, Perinatology and Child Health

Reference24 articles.

1. Postdischarge adverse events in children: a cause for concern;Tsilimingras;Jt Comm J Qual Patient Saf,2009

2. Caregiver perceptions of hospital to home transitions according to medical complexity: a qualitative study;Desai;Acad Pediatr,2016

3. Families’ priorities regarding hospital-to-home transitions for children with medical complexity;Leyenaar;Pediatrics,2017

4. Development of a new care model for hospitalized children with medical complexity;White;Hosp Pediatr,2017

5. U.S. Department of Health & Human Services; Administration for Children & FamiliesChildren’s Bureau. Trends in foster care and adoption. 2016. Available at: https://www.acf.hhs.gov/sites/default/files/cb/trends_fostercare_adoption_07thru16.pdf. Accessed September 22, 2017

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