title: Families' Priorities Regarding Hospital-to-Home Transitions for Children With Medical Complexity.
abstract: National health care policy recommends that patients and families be actively involved in discharge planning. Although children with medical complexity (CMC) account for more than half of pediatric readmissions, scalable, family-centered methods to effectively engage families of CMC in discharge planning are lacking. We aimed to systematically examine the scope of preferences, priorities, and goals of parents of CMC regarding planning for hospital-to-home transitions and to ascertain health care providers' perceptions of families' transitional care goals and needs.
  
  
  
  We conducted semistructured interviews with parents and health care providers at a tertiary care hospital. Interviews were continued until thematic saturation was reached. Interviews were audio recorded, transcribed verbatim, and analyzed to identify emergent themes via a general inductive approach.
  
  
  
  Thirty-nine in-depth interviews were conducted, including 23 with family caregivers of CMC and 16 with health care providers. Families' priorities, preferences, and goals for hospital-to-home transitions aligned with 7 domains: effective engagement with health care providers, respect for families' discharge readiness, care coordination, timely and efficient discharge processes, pain and symptom control, self-efficacy to support recovery and ongoing child development, and normalization and routine. These domains also emerged in interviews with health care providers, although there were minor differences in themes discussed.
  
  
  
  Although CMC have diverse transitional care needs, their families' priorities, preferences, and goals aligned with 7 domains that bridged their hospital admission with reestablishment of a home routine. This research provides essential foundational data to engage families in discharge planning, guiding the operationalization of national health policy recommendations.
authors.affiliation: Division of Pediatric Hospital Medicine, Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; jleyenaar@post.harvard.edu.|The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
authors.forename: JoAnna K
authors.initials: JK
authors.lastname: Leyenaar
authors.affiliation: The Ronald McDonald Children's Hospital of Loyola University Medical Center, Maywood, Illinois.
authors.forename: Emily R
authors.initials: ER
authors.lastname: O'Brien
authors.affiliation: Department of Pediatrics, Tufts Medical Center, Boston, Massachusetts.|American Board of Pediatrics, Chapel Hill, North Carolina.
authors.forename: Laurel K
authors.initials: LK
authors.lastname: Leslie
authors.affiliation: Center for Quality of Care Research and Division of General Medicine, Baystate Medical Center, Springfield, Massachusetts.|Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts; and.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
authors.affiliation: Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington.
authors.forename: Rita M
authors.initials: RM
authors.lastname: Mangione-Smith
mesh_terms: D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities; D006291:Health Policy; D006292:Health Priorities; D006701:Home Nursing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007406:Interview, Psychological; D010351:Patient Discharge; D010360:Patient Transfer; D014481:United States