Abstract
Background: In Switzerland, children with complex care needs (CCN), of whom one-fifth suffer from chronic health risks or disabilities, struggle to access the necessary support due to a fragmented health and social care system, leading to high readmission rates, increased costs, and family burden; accordingly, the SPARKLe project aims to develop, implement, and evaluate an transitional integrated care model to optimize the transition from hospital to home using a systematic methodological approach.
Approach: SPARKLe is a multiphase project following the Medical Research Council (MRC) framework and adopting implementation science principles. Phase A (between 2022 and 2023) involved an evaluation of the evidence, a contextual analysis using qualitative design guided by different implementation frameworks and models (individual interviews were conducted with 4 families, 12 healthcare professionals, and 8 leaders), and active stakeholder involvement. As a result, the SPARKLe care model was co-developed. In Phase B, the feasibility and initial implementation of the SPARKLe care model were tested in a real-world setting using mixed methods design: 3 general pediatric units at the Children’s University Hospital in Zurich, Switzerland were recruited to implement the SPARKLe integrated care model. Qualitative data was collected through focus groups and interviews of 6 families and 10 healthcare professionals respectively, while quantitative data was gathered from surveys and health records of 6 patients and 9 community healthcare providers post-discharge.
Results: Findings from the evaluation of the feasibility study (Phase B) demonstrated good acceptability of the SPARKLe integrated transitional care model among families of CCN children compared to the hospital care providers (nurses, MDs, therapy team and social workers). The study also demonstrated the need to improve the model’s reach, fidelity, and feasibility, particularly in components such as information transfer (fidelity 50%) and follow up post discharge (fidelity 0%) by a) implementing it in a supportive environment at the forefront of children with complex care needs; and b) providing continuous support to nursing staff to enhance clarity over their roles. The community health care providers reported 64% acceptance of the model and 63% feasibility of the collaboration with the hospital professionals with regards to the CCN care. Full evaluation of the effectiveness outcomes will follow in the effectiveness study (Phase C).
Implications: While adaptation of the peripheral components of the model is needed, the SPARKLe integrated transitional care model was highly accepted by families of CCN children. This implication indicates that SPARKLe can serve as a blueprint to scale it up to other Children’s Hospitals in Switzerland and beyond after the effectiveness study. To increase its reach, stronger leadership and efforts to involve community care providers in the referral process are essential.