Pediatric Hospital Discharges (Berry et al., 2016).

This study was done at the national level in order to evaluate the use of HHC (home health care) and PAC (facility-based post-acute care) for children who have been discharged from hospital. In particular, the study focused on the national frequency and variation of PAC and HHC use, and the characteristics of kids discharged to these facilities. This is because of the challenge in providing children with high quality pediatric care especially when they have complex medical conditions. The duration children take to recover after discharge presents a challenge to the families of these children in the form of increased home care which also affects expenses. Both these services optimize the health of the patient and also avoids potential hospital readmissions. One study found the benefits of HHC to include family stability and child survival (Boss et al., 2019).
This retrospective cohort study used a large sample of 2,423,031 children discharged from 4,179 hospitals in the US. A cohort study distinguishes between a group that has been exposed to a risk factor and another without risk factor exposure over a duration of time for analysis (Song & Chung, 2010). Random sampling was used to obtain 10% of uncomplicated births, 80% of complicated births and nonbirth discharges and multivariable analysis resulting to strong statistical power of P < .05. The variables used in this study include: the clinical and demographic characteristics of the discharged child, hospital characteristics and the discharge disposition which was broken down into the number of HHC discharges, PAC discharges and other child discharges. Bivariable analysis was used to compare the clinical and demographic features of hospitalized children according to their discharge nature. Multivariable analysis of hospital, clinical and demographic characteristics was used to determine disparity in home health care.
The study found that 1 in 20 hospitalized children in the US are discharged to PAC or HHC in the United States, which is significantly lower compared to that of adults. Many of these children often have complex medical conditions. The low usage by children may be due to inadequate supply of PAC’s and HHC nurses with pediatric expertise, limited approval and access by payers and second-rate payment for the above services for children. The highest percentage of hospitalizations with PAC discharge was linked to non-neonatal care, with the most common complications being respiratory issues. Additionally, the use of PAC and HHC after the patient discharges meaningfully vary by ethnicity. There are no guidelines or regulations to decide the children qualified for PAC and HHC which further explains the variation. The study had some limitations including inadequate information to differentiate children still in hospitalization after treatment of their conditions and inadequate information on the type, amount or cost of physician linked to PAC or HHC.
These findings imply that health services offered by PAC’s and HHC’s are underutilized and variably used by children as much as adults when the discharged children present with several chronic medical conditions. The lack of PAC and HCC guidelines accounts for a significant variation in referral rates. This can be addressed by implementing a uniform evaluation model for patients discharged to PAC and HHC and also creating site-neutral PAC payments. Bundled payments motivate hospitals to lower average length of stay and choose lower cost PAC alternatives (Burke et al., 2017). Further research is required to identify ways in which these services can be incorporated into pediatric care so as to positively impact the health outcomes of discharged children and reduce care costs. One of the proposed strategies is improving transitional hospital care to ensure successful health outcomes in PAC. Additionally, there needs to be evidence showing whether using HHC and PAC services efficiently meets the needs of the children after being discharged. The findings reveal the necessity for outcome studies. The inadequate utilization of PAC for children can be explored by research concentrating on the effects of being discharged from an acute care facility to stay at home with no services compared to getting numerous types of care after being discharged from acute care (Phillips et al., 2018). This calls for more qualitative research involving service providers and patient conditions to provide more information regarding the decision-making involved in PAC and HHC discharges for children. Important considerations should also go into assessing the role of service availability, patient preference and the willingness and ability of the patient’s family to assist in care. Finally, the study can be repeated when the limitations listed above are addressed in order to increase the accuracy and reliability of the study.

References

Berry, J., Hall, M., Dumas, H., Simpser, E., Whitford, K., & Wilson, K. et al. (2016). Pediatric Hospital Discharges to Home Health and Postacute Facility Care. JAMA Pediatrics, 170(4), 326. https://doi.org/10.1001/jamapediatrics.2015.4836

Boss, R., Raisanen, J., Detwiler, K., Fratantoni, K., Huff, S., Neubauer, K., & Donohue, P. (2019). Lived Experience of Pediatric Home Health Care Among Families of Children With Medical Complexity. Clinical Pediatrics, 59(2), 178-187. https://doi.org/10.1177/0009922819894006

Burke, R., Cumbler, E., Coleman, E., & Levy, C. (2017). Post–Acute Care Reform: Implications and Opportunities for Hospitalists. The Journal Of Hospital Medicine, 12(1), 46-51. https://doi.org/10.1002/jhm.2673

Phillips, C., Truong, C., Kum, H., Nwaiwu, O., & Ohsfeldt, R. (2018). Post-acute care for children with special health care needs. Disability And Health Journal, 11(1), 49-57. https://doi.org/10.1016/j.dhjo.2017.08.010

Song, J., & Chung, K. (2010). Observational Studies: Cohort and Case-Control Studies. Plastic And Reconstructive Surgery, 126(6), 2234-2242. https://doi.org/10.1097/prs.0b013e3181f44abc