Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial

Pediatrics. 2018 Aug;142(2):e20174278. doi: 10.1542/peds.2017-4278. Epub 2018 Jul 11.


Objectives: We sought to examine the effect of a caregiver coaching intervention, Plans for Action and Care Transitions (PACT), on hospital use among children with medical complexity (CMC) within a complex care medical home at an urban tertiary medical center.

Methods: PACT was an 18-month caregiver coaching intervention designed to influence key drivers of hospitalizations: (1) recognizing critical symptoms and conducting crisis plans and (2) supporting comprehensive hospital transitions. Usual care was within a complex care medical home. Primary outcomes included hospitalizations and 30-day readmissions. Secondary outcomes included total charges and mortality. Intervention effects were examined with bivariate and multivariate analyses.

Results: From December 2014 to September 2016, 147 English- and Spanish-speaking CMC <18 years old and their caregivers were randomly assigned to PACT (n = 77) or usual care (n = 70). Most patients were Hispanic, Spanish-speaking, and publicly insured. Although in unadjusted intent-to-treat analyses, only charges were significantly reduced, both hospitalizations and charges were lower in adjusted analyses. Hospitalization rates (per 100 child-years) were 81 for PACT vs 101 for usual care (adjusted incident rate ratio: 0.61 [95% confidence interval 0.38-0.97]). Adjusted mean charges per patient were $14 206 lower in PACT. There were 0 deaths in PACT vs 4 in usual care (log-rank P = .04).

Conclusions: Among CMC within a complex care program, a health coaching intervention designed to identify, prevent, and manage patient-specific crises and postdischarge transitions appears to lower hospitalizations and charges. Future research should confirm findings in broader populations and care models.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Caregivers / education*
  • Child
  • Child, Preschool
  • Comprehensive Health Care / methods
  • Comprehensive Health Care / trends
  • Female
  • Hospitalization / trends
  • Humans
  • Male
  • Mentoring / methods*
  • Mentoring / trends
  • Patient Discharge* / trends
  • Patient Readmission* / trends
  • Patient Transfer / methods*
  • Patient Transfer / trends
  • Patient-Centered Care / methods
  • Patient-Centered Care / trends