Trial to Reduce Hospitalizations in Children With Medical Complexity

Randomized Controlled Trial to Decrease Admission Rates in Medically Complex Children in a Medical Home Program

The investigators hypothesize that an intervention, within an established patient-centered medical home, aimed at reducing modifiable risks for hospitalization, can decrease hospital utilization among medically complex children.

The investigators will pilot test an intervention that includes contingency planning and care transitions within an established medical home program caring for children with medical complexity. Children with medical complexity receiving care within the UCLA Medical Home Program will be randomized to the pilot intervention or usual medical home care. The primary goal will be to reduce admissions and readmissions in the intervention group.

Inclusion Criteria:

• Children ages 0 to 17 years old who are enrolled in the Pediatric Medical Home Program at UCLA
• English and Spanish-speaking only

Exclusion Criteria:

• Children older than 17 years old who are enrolled in the Pediatric Medical Home Program
• Non-English and Non-Spanish speakers