Collaborative Model of Care for Children With Medical Complexity: A Randomized Clinical Trial.

Abstract

Improving home health (HH) care for children with medical complexity (CMC) is critical. We developed ICollab, a care model involving collaboration between a children's hospital's complex care clinicians, HH nurses, and primary care providers. We sought to evaluate ICollab's effectiveness in reducing hospitalizations, emergency department (ED) visits, and caregiver burden and improving health care provider collaboration. In this randomized controlled trial (November 2019 to February 2023) in North Carolina, 96 CMC discharged with HH nursing were randomized to receive ICollab with usual care (intervention; n = 50) vs usual care only (control; n = 46) for 6 months. Outcomes were hospitalization rate, hospital days, days to hospitalization, ED visit rate, and days to ED visit (primary); caregiver time coordinating care and Impact on Family Scale (secondary); and measures of health care provider collaboration and satisfaction with care (intermediate). Between the 2 arms, there was no difference in proportion with at least 1 hospitalization (43% vs 36%; P = .47). In children with at least 1 hospitalization, intervention vs control group had lower hospitalization rate (280/100 vs 840/100 child-years; P = .01) and hospital days (4.8% vs 13%; P = .01). There was no difference between the arms in ED visit metrics. There was a significant reduction in time spent coordinating care (1-4 scale), with ICollab (3.23) vs control (3.68; P = .02). There were no group differences in other secondary or intermediate outcomes. Contrary to our hypothesis, ICollab did not reduce hospitalization or ED visit metrics. ICollab reduced caregiver time coordinating care but had no effect on other outcomes. Larger studies are necessary to evaluate ICollab's effectiveness.