Is out‐patient based treatment of bronchiectasis exacerbations in children comparable to inpatient based treatment?

Abstract

Background and Objective Children with bronchiectasis have recurrent exacerbations and may require hospitalization. “Hospital in the home (HITH)” is used as an alternative to hospitalization for children with cystic fibrosis (CF) but to date, there is no published data on children without CF. We describe our experience of HITH (intravenous [IV] antibiotics and at least once‐daily physiotherapy‐treated airway clearance therapy) in a cohort of children with bronchiectasis, comparing outcomes between hospital and HITH‐based pathways. Methods Medical records were retrospectively reviewed in children with bronchiectasis who were hospitalized in our center from July 2016 to July 2018. We compared treatment duration, symptom resolution, adverse events, oral antibiotic prescription on discharge and “time‐to‐next hospitalization” between children managed with the two treatment pathways. Results Exacerbations in 63 children (median age = 6 years [range: 1‐17]; females = 33, indigenous = 8) with bronchiectasis treated with IV antibiotic therapy were analyzed (HITH n = 45, 71.5%). Duration of treatment and symptom resolution was similar between groups (hospital: median = 14 days [interquartile range {IQR}: 14‐14] and 12/18 [66.6%], respectively vs HITH: 14 [14‐15.5] and 31/45 [69%]; P = .53 and .85, respectively). There was no significant difference in adverse events (16.6% vs 9%), prescription of oral antibiotics on discharge (44% vs 24%), or “time‐to‐next hospitalization” (median 42 [IQR: 24‐100] vs 67 [IQR: 32‐95] weeks) between hospital and HITH groups, respectively. Conclusions In children with bronchiectasis treated for a severe exacerbation, receiving treatment in the home setting with HITH does not compromise short‐term clinical outcomes compared to hospital only treatment. Prospective studies are required to provide more robust evidence in this under‐researched area.

Cost of hospitalization for bronchiectasis exacerbation in children

“…Hospitalization resource use data for each patient was determined and costed by the QCH Finance Department applying the Independent Hospital Pricing Authority (IHPA) Hospital Patient Costing Standards v3.1 (July 2014) 20. Children receiving HITH had daily nursing visits for antibiotics and twice daily physiotherapist visits for airway clearance therapy, similar to the care received in hospital (Appendix S1 in Supplementary Information) 21…”

“…20 Children receiving HITH had daily nursing visits for antibiotics and twice daily physiotherapist visits for airway clearance therapy, similar to the care received in hospital (Appendix S1 in Supplementary Information). 21…”

Does the Implementation of Children's Hospital in the Home affect Health Outcomes for Children with Chronic Respiratory Conditions? A non-contemporary retrospective cohort comparison study

“…However, due to limited numbers of patients with non-CF bronchiectasis and PCD during the study period we could not make any firm conclusions about the benefit of the model of care regarding this cohort. Although a recent study by O'Rourke et al [22] indicates that children with non-CF bronchiectasis can be managed safely at home while achieving comparable outcomes.…”

“…Issues of note include increased absenteeism from school, carer's leave and high levels of antibiotic use when treated in hospital [20]. Two other recent studies found that children with non-CF bronchiectasis could be safely managed within the home environment and achieve comparable outcomes while reducing healthcare costs [21,22].…”

Counting the cost of bronchiectasis

“…clearly shows that longer length of hospital stays and not receiving treatment by hospital in the home services significantly contribute to increased healthcare costs. Observational studies in adults and children with bronchiectasis have shown that home‐based treatment for exacerbations was safe, and resulted in less morbidity, and was as effective as hospital‐based treatment, including similar clinical and quality of life improvement and 30‐day readmission rates, and significantly reduced the hospitalization days, thus reducing the healthcare costs 7 . Potential advantages of outpatient provision of intravenous antibiotics in patients with bronchiectasis go beyond cost reductions but include reducing the risk of cross‐infection, improvement in patient's quality of life by spending less time in hospital and less disruption to family life.…”