The Moral Imperative of Home Health Care for Children: Beyond the Financial Case

Noritz, Garey

doi:10.1542/peds.2018-2960

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…Over half of children with tracheostomies have ≥2 additional devices 2 and 90% of children receiving home ventilation have complex medical conditions, including more than 50% with moderate/severe neurologic impairment 3 . Thus many parents are managing multiple technologies, medications, and daily medical interventions in their homes; often without reliable or qualified pediatric home nursing staff, further challenging and stressing family balance 4–8 …”

Section: Introductionmentioning

confidence: 99%

Life with pediatric home ventilation: Expectations versus experience

Henderson

Raisanen

Shipman

et al. 2021

Pediatric Pulmonology

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Objectives To explore the family experience of home ventilation through a comparison of anticipated home life changes with subsequent experiences. Study Design Guided interviews with parents across three states who chose home ventilation for their child within the last 5 years. Patient‐Subject Selection Purposive sampling of parents who chose home ventilation for their child within the last 5 years. Methods Interviews were transcribed for qualitative analysis and analyzed for thematic saturation and prevalence of codes. Results Twenty families were interviewed. Families generally reported not considering potential home life changes when facing the decision about home ventilation; instead, they worried most about medical management. These concerns reversed in importance later. Families learned medical management quickly but felt largely unprepared for the extensive changes to their home life, including isolation, altered relationships with extended family and community, effects on siblings, financial strain, and need for physical changes to their house. Families had not anticipated how much they would be affected by home healthcare as a new part of their life. Conclusions The priorities that families consider during decisions about pediatric home ventilation may not be aligned with the actual home experience of this technology. Given that the success of home ventilation largely rests with the family's care, family expectations for home life adaptations must be augmented, as should postdischarge supports for families with complex home care experiences.

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Section: Introductionmentioning

confidence: 99%

Life with pediatric home ventilation: Expectations versus experience

Henderson

Raisanen

Shipman

et al. 2021

Pediatric Pulmonology

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“…In order to use the limited number of intensive care beds more efficiently, to reduce the complications of staying in the intensive care unit, to provide moral support and to improve the quality of life, it is recommended that the stable intensive care patient whose emergency condition improves, should be taken care of at home. 1,[5][6][7][8] The length of hospital stay of patients is prolonged due to insufficient discharge planning and home care services. The home care team should coordinate the health care of children who are dependent on complex medical technology and need home care.…”

Section: Introductionmentioning

confidence: 99%

Determining the Difficulties of Parents with Children in Home Care Who Were Discharged from Intensive Care

Bozkurt,

Sönmez Düzkaya,

Uysal

et al. 2024

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“…[1][2][3]5,6 Home nursing shortages have been implicated as a primary driver of prolonged length of hospital stays among children with medical complexity (CMC). [7][8][9][10][11][12][13][14][15] Moreover, inadequate home nursing has been associated with parental financial instability, social isolation, depression, and sleep loss. 7,16,17 Existing estimates of posthospitalization home nursing among CMC are based on hospital discharge data (ie, discharge disposition to home nursing or indication in the hospital chart that home nursing was anticipated) rather than on actual use.…”

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confidence: 99%

State Variation in Posthospital Home Nursing for Commercially Insured Medically Complex Children

et al. 2020

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BACKGROUND AND OBJECTIVES: Home nursing is essential for children with medical complexity (CMC), but provision varies substantially across states. Our objectives were to quantify state-to-state variability in distribution of posthospitalization home nursing to commercially insured CMC and to rank-order states.METHODS: Retrospective cohort study of hospitalized commercially insured children with $1 complex chronic condition from birth to 18 years of age in the Truven MarketScan database. Cohort eligibility criteria were hospital discharge between January 2013 and November 2016 and at least 30 days of follow-up after discharge. Two primary outcome measures were used: receipt of any home nursing within 30 days of hospital discharge (yes or no) and number of days of posthospitalization home nursing (1-30 days). A composite metric encompassing both receipt and quantity was created by evaluating the 95th percentile of days of home nursing (0-30 days).RESULTS: Overall, 9.9% of the sample received home nursing. After we adjusted for patient characteristics, the probability of receiving home nursing varied across states, ranging from 3.4% to 19.2%. Among home nursing recipients, the adjusted median home nursing days across states ranged from 6.6 to 24.5 days. The adjusted 95th percentile of days of home nursing (across the entire of sample, including recipients and nonrecipients of home nursing) ranged from 6.8 to 22.6 days. CONCLUSIONS:We observed striking state-to-state variability in receipt of home nursing and mean number of days of posthospitalization home nursing among commercially insured CMC after adjustment for demographic and clinical differences. This suggests opportunities for state-level improvement.WHAT'S KNOWN ON THIS SUBJECT: Home nursing is an essential service for children with medical complexity. Estimates of posthospital home nursing prevalence vary widely, and state differences have been suggested.WHAT THIS STUDY ADDS: In a commercial insurance claims database, substantial state-to-state variability in provision of posthospitalization home nursing to children with medical complexity was quantified. Using a novel reproducible composite metric, states were ranked on the basis of their provision of home nursing services.

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The Moral Imperative of Home Health Care for Children: Beyond the Financial Case

Cited by 3 publications

References 7 publications

Life with pediatric home ventilation: Expectations versus experience

Life with pediatric home ventilation: Expectations versus experience

Determining the Difficulties of Parents with Children in Home Care Who Were Discharged from Intensive Care

State Variation in Posthospital Home Nursing for Commercially Insured Medically Complex Children

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