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Randomized Controlled Trial of Health Coaching for Parents of Children with Medical Complexity

      Abstract

      Background and Objective

      Parents of children with medical complexity (CMCs) struggle with managing their children's care needs. Health coaching provides patients with tools to take ownership of their care. We sought to assess the impact of health coaching for parents of CMCs on activation, child's health related quality of life (HRQL), and utilization.

      Methods

      Parents of CMCs receiving primary care at two academic primary care practices were randomized to receive 3-6 months of coaching from a trained health coach (n=54) or usual care (n=71). Parents were surveyed on activation, HRQL, and experience of care at baseline and the end of the study period. Markers of utilization (missed visit rates, ED, and admissions) were measured for 12 months prior to and after enrollment. Parametric, non-parametric, and Poisson regression were used to assess baseline differences in characteristics and average pre-post differences between the groups.

      Results

      At baseline, activation and rating of patient experience were high in both groups, while HRQL was one standard deviation below the population-based mean. Both groups had slight increases in HRQL and P-PAM without significant differences between groups. ED visits declined significantly more in the intervention group than the usual care group (0.68 visits, (-0.03, -1.32) p=0.04); there were non-significant differences in changes in other utilization metrics.

      Conclusion

      Health coaching was associated with a decrease in ED use but not in changes in activation, patient experience, or HRQL. More inquiry is needed to understand whether health coaching is an effective modality for improving care for children with medical complexity.

      Keywords

      Abbreviations:

      CMC (Children with medical complexity), HRQL (Health related quality of life), P-PAM (Parent Patient Activation Measure), PGH (Pediatric Global Health), ED (Emergency department), TIDieR (Template for Intervention Description and Replication)
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