Strategies to support transitions from hospital to home for children with medical complexity: A scoping review

Abstract

Background: Children with medical complexity constitute a small but resource-intensive subgroup of children with special health care needs. Their medical fragility and resource-intensive needs put them at greater risk for inadequate transitions from hospital to home-based care, and subsequent adverse outcomes and hospital re-admissions.

Objective: This scoping literature review was conducted to map empirically researched interventions, frameworks, programs or models that could inform or support the transition from hospital to home for children with medical complexity.

Design: We conducted a scoping review using the methodology outlined by the Joanna Briggs Institute.

Data sources: In consultation with an experienced librarian, we searched PubMed, EMBASE and CINAHL for English-language articles published from the date of origin to February 2016. We also hand-searched four high impact journals and searched the reference lists of relevant articles.

Review methods: Two reviewers independently screened the literature results according to inclusion criteria. Empirically designed studies that targeted children <18years old who were specifically defined as medically complex or fragile and transitioning from acute care to home were included. Data were extracted using a predefined tool. Quality appraisal of the articles was conducted using the mixed methods appraisal tool (MMAT). Thematic analysis was carried out to identify existing patterns or trends in the included studies.

Results: Of the 2088 abstracts retrieved, 14 studies met the inclusion criteria. Following analysis, we identified three major categories of interventions: Comprehensive care plans (n=3), Complex Care Programs (n=8) and Integrated delivery models (n=3). The overall quality of included studies was moderate, with 21% (n=3) scoring 0.25, 29% (n=4) scoring 0.50, 43% (n=6) scoring 0.75, and 7% (n=1) scoring 1.0.

Conclusions: In the absence of evidence-based guidelines to ensure adequate transitions from hospital to home for children with medical complexity, identification of potential models to support this transition is imperative. We identified interventions, frameworks, models and programs in the literature that might inform the development of such guidelines; however, there is a need for consensus around the definition for children with medical complexity and the limited number of these studies and lack of high quality of evidence signals the need for further research to improve the transition from hospital to home and ultimately, improve patient and family outcomes.

Keywords: Children with medical complexity; Complex care needs; Health care professional; Nursing; Paediatrics; Scoping review; Transitional care.