Association of Home Respiratory Equipment and Supply Use with Health Care Resource Utilization in Children

Berry, Jay G.; Goodman, Denise M.; Coller, Ryan J.; Agrawal, Rishi; Kuo, Dennis Z.; Cohen, Eyal; Thomson, Joanna; DeCourcey, Danielle; deJong, Neal A.; Agan, Anna A.; Gaur, Dipika; Coquillette, Madeline; Crofton, Charis; Houtrow, Amy J.; Hall, Matt

doi:10.1016/j.jpeds.2018.11.046

Cited by 20 publications

(22 citation statements)

References 25 publications

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“…Choosing home ventilation can promote the growth and survival of the child but can lead to tremendous burdens on families and children that have long been associated with technology dependence at home 1 . These may include increased reliance on the healthcare system, 2–4 financial hardship, 5 disruption of life at home, 6,7 social isolation, 7,8 and emotional strain, 9 among other problems 1 . Alternative choices could lead to progressive morbidity or death.…”

Section: Introductionmentioning

confidence: 99%

Parent perspectives on facilitating decision‐making around pediatric home ventilation

Jabre

Raisanen

Shipman

et al. 2021

Pediatric Pulmonology

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Rationale Deciding about pediatric home ventilation is exceptionally challenging for parents. Understanding the decision‐making needs of parents who made different choices for their children could inform clinician counseling that better supports parents’ diverse values and goals. Objectives To determine how clinicians can meet the decisional needs of parents considering home ventilation using a balanced sample of families who chose for or against intervention. Methods We conducted semi‐structured interviews of parents who chose for or against home ventilation for their child within the previous 5 years. Parents were recruited from three academic centers across the United States. Interviews focused on parent–clinician communication during decision‐making and how clinicians made the process easier or more difficult. Qualitative analysis was used to generate themes and identify key results. Results Thirty‐eight parents were interviewed; 20 chose for and 18 chose against home ventilation. Five themes described their perspectives on how clinicians can facilitate high‐quality decision‐making: demonstrating dedication to families, effectively managing the medical team, introducing the concept of home ventilation with intention, facilitating meaningful conversation about the treatment options, and supporting and respecting the family's decision. Conclusions High‐quality decision‐making around home ventilation depends on individual clinician actions and the complex operations of large academic settings. Strong working relationships with parents, collaborative alliances with colleagues, and appropriate delivery of key content can help meet the needs of parents considering invasive breathing supports for their children.

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Section: Introductionmentioning

confidence: 99%

Parent perspectives on facilitating decision‐making around pediatric home ventilation

Jabre

Raisanen

Shipman

et al. 2021

Pediatric Pulmonology

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“…In contrast to the literature, we found relatively high concordance of TA between diagnostic and procedure code-based identification of TA and our point-of-care chart review screening. 19 For example, when comparing TA by using screening versus diagnostic codes, we found 100% vs 97% of CMC, 21% vs 29% of CSHCN, and 0% vs 3% of PH children required TA. Of note, CSHCN and PH children were more likely to be identified as using technology through using diagnostic codes, compared to our definition.…”

Section: Discussionmentioning

confidence: 88%

Point-of-Care Complexity Screening Algorithm to Identify Children With Medical Complexity

Parente¹,

Parnell²,

Childers

et al. 2021

Hospital Pediatrics

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OBJECTIVES: For pediatric complex care programs to target enhanced care coordination services to the highest-risk patients, it is critical to accurately identify children with medical complexity (CMC); however, no gold standard definition exists. The aim of this study is to describe a point-of-care screening algorithm to identify CMC with high health care use, a group that may benefit the most from improved care coordination. METHODS: From July 1, 2015, to June 30, 2016 (fiscal year 2016 [FY16]), a medical complexity screening algorithm was implemented by a pediatric complex care program at a single tertiary care center for hospitalized patients at the time of admission. Using the screening algorithm, we categorized inpatients into 1 of 3 groups: CMC, children with special health care needs (CSHCN), or previously healthy (PH) children. Inpatient resource use for FY16 and FY17 encounters was extracted for children screened in FY16. RESULTS: We categorized 2187 inpatients in FY16 into the 3 complexity groups (CMC = 77; CSHCN = 1437; PH children = 673). CMC had more complex chronic conditions (median = 6; interquartile range [IQR] 4–11) than CSHCN (median = 1; IQR 0–2) and PH children (median = 0; IQR 0–0). CMC had greater per-patient and per-encounter hospital use than CSHCN and PH children. CMC and children with ≥4 complex chronic conditions had comparable levels of resource use. CONCLUSIONS: By implementation of a point-of-care screening algorithm, we identified CMC with high health care use. By using this algorithm, it was feasible to identify hospitalized CMC that could benefit from care coordination by a pediatric complex care program.

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“…Although data regarding HMV specific to children with SNI is limited, there is growing information about outcomes 17–19 . Existing literature suggests that children with SNI who require HMV early in life are likely to remain on mechanical ventilation 17 .…”

Section: Discussionmentioning

confidence: 99%

Home mechanical ventilation for children with severe neurological impairment: Parents' perspectives on clinician counselling

Bogetz

Munjapara

Henderson

et al. 2022

Develop Med Child Neuro

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Children with severe neurological impairment (SNI) have central nervous system disorders that arise in childhood and result in motor and cognitive impairment as well as complex developmental disability that requires much assistance with activities of daily living. 1 Some children with SNI receive home mechanical ventilation (HMV), defined as invasive ventilatory support with a tracheostomy and therefore clinician counseling must include relevant information about its known risks and benefits. 2,3 Counseling about HMV for children with SNI depends on many factors and is challenging for both parents and clinicians. 4,5 Children with SNI often have overlapping chronic

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Association of Home Respiratory Equipment and Supply Use with Health Care Resource Utilization in Children

Cited by 20 publications

References 25 publications

Parent perspectives on facilitating decision‐making around pediatric home ventilation

Parent perspectives on facilitating decision‐making around pediatric home ventilation

Point-of-Care Complexity Screening Algorithm to Identify Children With Medical Complexity

Home mechanical ventilation for children with severe neurological impairment: Parents' perspectives on clinician counselling

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