Hospital-to-home transition for children with asthma-related hospitalizations: A study protocol for a pragmatic randomized controlled trial.

Abstract

Asthma is one of the most common chronic diseases of childhood with morbidity disproportionately affecting children across different racial and/or ethnic groups and socioeconomic statuses, specifically Black children and those living in poverty. Hospitalization for asthma is a significant risk factor for future readmissions. The Hospital-to-Home (H2H) study seeks to improve asthma care and outcomes by focusing on the transition home after hospitalizations. The H2H study is a pragmatic, randomized controlled trial comparing the H2H intervention to usual care. The intervention involves 12 months of care coordination from an asthma navigator. Participants are enrolled during hospitalization from either a freestanding urban children's hospital or an affiliated community hospital. The primary outcome is readmission for asthma within 12 months of index asthma-related hospital admission. Secondary outcomes include caregiver asthma-related quality of life, self-efficacy for asthma management, perceived stress, and resilience. Children admitted with asthma exacerbations represent an at-risk population, thus hospitalization offers a critical opportunity to deliver timely, meaningful interventions that can support sustained improvements in their care and improve long-term outcomes. Despite the majority of asthma hospitalizations occurring in community hospitals, past studies have focused on freestanding children's hospitals. To improve the generalizability of our findings, we also enroll children from a community hospital. Optimizing care with the H2H intervention offers an opportunity to reduce asthma morbidity in an at-risk pediatric cohort by leveraging high-touch, cost-effective asthma navigators for intensive coordination while maintaining low-touch provider oversight to ensure safety and sustainability.