title: Testing a post-discharge nurse-led transitional home visit in acute care pediatrics: the Hospital-To-Home Outcomes (H2O) study protocol.
abstract: OBJECTIVE
  The aims of this study were: (1) to explore the family perspective on pediatric hospital-to-home transitions; (2) to modify an existing nurse-delivered transitional home visit to better meet family needs; (3) to study the effectiveness of the modified visit for reducing healthcare re-use and improving patient- and family-centered outcomes in a randomized controlled trial.
  
  
  BACKGROUND
  The transition from impatient hospitalization to outpatient care is a vulnerable time for children and their families; children are at risk for poor outcomes that may be mitigated by interventions to address transition difficulties. It is unknown if an effective adult transition intervention, a nurse home visit, improves postdischarge outcomes for children hospitalized with common conditions.
  
  
  METHODS
  (1) Descriptive qualitative; (2) Quality improvement; (3) Randomized controlled trial.
  
  
  METHODS
  Aim 1 will use qualitative methods, through focus groups, to understand the family perspective of hospital-to-home transitions. Aim 2 will use quality improvement methods to modify the content and processes associated with nurse home visits. Modifications to visits will be made based on parent and stakeholder input obtained during Aims 1 & 2. The effectiveness of the modified visit will be evaluated in Aim 3 through a randomized controlled trial.
  
  
  CONCLUSIONS
  We are undertaking the study to modify and evaluate a nurse home visit as an effective acute care pediatric transition intervention. We expect the results will be of interest to administrators, policy makers and clinicians interested in improving pediatric care transitions and associated postdischarge outcomes, in the light of impending bundled payment initiatives in pediatric care.
authors.affiliation: Research in Patient Services/Division of Nursing & James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Ohio, USA.
authors.forename: Heather L
authors.identifier: http://orcid.org/0000-0002-1662-1368
authors.initials: HL
authors.lastname: Tubbs-Cooley
authors.affiliation: The Ohio State University, Columbus, Ohio, USA.
authors.forename: Rita H
authors.initials: RH
authors.lastname: Pickler
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Ohio, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Simmons
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Ohio, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Auger
authors.affiliation: Divisions of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio, USA.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Beck
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Ohio, USA.
authors.forename: Hadley S
authors.initials: HS
authors.lastname: Sauers-Ford
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Ohio, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Sucharew
authors.affiliation: Division of Pediatric Hospital Medicine, University of Rochester Medical Center Golisano Children's Hospital, New York, USA.
authors.forename: Lauren G
authors.initials: LG
authors.lastname: Solan
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Ohio, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: White
authors.affiliation: SNS Research, Cincinnati, Ohio, USA.
authors.forename: Susan N
authors.initials: SN
authors.lastname: Sherman
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Ohio, USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Statile
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Ohio, USA.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000208:Acute Disease / Q000451:nursing*; D002648:Child; D002662:Child Health Services / Q000458:organization & administration / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards*; D006699:Home Care Services / Q000458:organization & administration / Q000592:standards*; D006792:House Calls; D006801:Humans; D020380:Needs Assessment; D009820:Ohio; D010342:Patient Acceptance of Health Care; D010351:Patient Discharge / Q000592:standards; D010360:Patient Transfer / Q000458:organization & administration / Q000592:standards*; D010371:Pediatric Nursing / Q000458:organization & administration / Q000592:standards; D019233:Retreatment
keywords: home health; nursing; patient-centered outcomes research; pediatrics; transitions