Nursing-led Home Visits Post-hospitalization for Children with Medical Complexity.
OBJECTIVE
Hospital discharge for children with medical complexity (CMC) can be challenging for families. Home visits could potentially benefit CMC and their families after leaving the hospital. We assessed the utility of post-discharge home visits to identify and address health problems for recently hospitalized CMC.


METHODS
A prospective study of 36 CMC admitted to a children's hospital from 4/15/2015 to 4/14/2016 identified with a possible high risk of hospital readmission and offered a post-discharge home visit within 72h of discharge. The visit was staffed by a hospital nurse familiar with the child's admission. The home visit goals were to reinforce education of the discharge plan, assess the child's home environment, and identify and address any problems or issues that emerged post-discharge.


RESULTS
The children's median age was 6years [interquartile range (IQR) 2-18]. The median distance from hospital to their home was 38miles (IQR 8-78). All (n=36) children had multiple chronic conditions; 89% (n=32) were assisted with medical technology. The nurse identified and helped with a post-discharge problem during every (n=36) visit. Of the 147 problems identified, 26.5% (n=39) pertained to social/family issues (e.g., financial instability), 23.8% (n=35) medications (e.g., wrong dose), 20.4% (n=30) durable medical equipment (e.g., insufficient supply or faulty function), 20.4% (n=30) child's home environment (e.g., unsafe sleeping arrangement), and 8.8% (n=13) child's health (e.g., unresolved health problem).


CONCLUSIONS
Home visits helped identify and address post-discharge issues that occurred for discharged CMC.


CONCLUSIONS
Hospitals should consider home visits when optimizing discharge care for CMC.
Department of Nursing, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, United States. Electronic address: sarah.wells@childrens.harvard.edu.
Sarah
S
Wells
Department of Medicine, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, United States. Electronic address: margaret.oneill@childrens.harvard.edu.
Margaret
M
O'Neill
Department of Nursing, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, United States. Electronic address: jayne.rogers@childrens.harvard.edu.
Jayne
J
Rogers
Department of Medicine, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, United States. Electronic address: kevin.blaine@childrens.harvard.edu.
Kevin
K
Blaine
Department of Nursing, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, United States. Electronic address: amy.hoffman@childrens.harvard.edu.
Amy
A
Hoffman
Department of Medicine, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States. Electronic address: sarah.mcbride@childrens.harvard.edu.
Sarah
S
McBride
Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Rubenstein Child Health Building, Baltimore, MD 21287, United States. Electronic address: mtschud1@jhmi.edu.
Meghan M
MM
Tschudy
Department of Medicine, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States; Boston Medical Center, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, United States. Electronic address: igor.Shumskiy@childrens.harvard.edu.
Igor
I
Shumskiy
Department of Medicine, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, United States.
Sangeeta
S
Mauskar
Department of Medicine, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States. Electronic address: jay.berry@childrens.harvard.edu.
Jay G
JG
Berry
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019988:Children with Disabilities; D006699:Home Care Services / Q000458:organization & administration*; D006776:Hospitals, Pediatric; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D000076322:Multimorbidity; D010351:Patient Discharge; D010360:Patient Transfer / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D014481:United States
Children with medical complexity; Home visits; Hospital discharge; Post-discharge care; Transitions of care