Home Health Care Availability and Discharge Delays in Children With Medical Complexity
Home Health Care Availability and Discharge Delays in Children With Medical Complexity
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DOI：
10.1542/peds.2018-1951
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发表时间：
2019-01-01
期刊：
影响因子：
8
通讯作者：
Wheeler, William
中科院分区：
文献类型：
--
作者：
Maynard, Roy;Christensen, Eric;Wheeler, William
背景：越来越多的儿科住院日归因于技术依赖儿童。儿科家庭护理（HCN）短缺的影响，增加住院时间和再入院在这个population.METHODS：我们进行了一项为期12个月的多地点前瞻性研究，医疗复杂性出院的儿童与家庭健康。我们研究了以下2个队列：首次出院到家庭护理的新患者和出院到以前建立的家庭护理的现有患者。一个修改后的延迟工具被用来分类的原因，延迟出院（DD）天，和计划外90天recommissis.Results：DD发生在68.5%的54例新患者和9.2%的131名现有患者。缺乏HCN是DD的最常见原因，增加了成本，并直接导致新患者和现有患者的平均住院时间分别增加了53.9天（范围：4-204）和35.7天（3-63）。在1582例DD中，1454例（91.9%）直接归因于缺乏HCN可用性。DD与年龄较小和气管切开术相关。计划外的90天再入院是由于医疗挫折（96.7%的情况下），发生在53.7%和45.0%的新的和现有的patients.CONCLUSIONS：DD和相关费用主要与短缺的HCN和主要影响新的HCN患者。医疗挫折是90天计划外再入院的最常见原因。增加家庭护理护士或急性后护理设施的可用性可以减少昂贵的住院时间。
BACKGROUND: An increasing proportion of pediatric hospital days are attributed to technology-dependent children. The impact that a pediatric home care nursing (HCN) shortage has on increasing length of hospital stay and readmissions in this population is not well documented.METHODS: We conducted a 12-month multisite prospective study of children with medical complexity discharging with home health. We studied the following 2 cohorts: new patients discharging for the first time to home nursing and existing patients discharging from the hospital to previously established home nursing. A modified delay tool was used to categorize causes, delayed discharge (DD) days, and unplanned 90-day readmissions.RESULTS: DD occurred in 68.5% of 54 new patients and 9.2% of 131 existing patients. Lack of HCN was the most frequent cause of DD, increasing costs and directly accounting for an average length of stay increase of 53.9 days (range: 4-204) and 35.7 days (3-63) for new and existing patients, respectively. Of 1582 DDs, 1454 (91.9%) were directly attributed to lack of HCN availability. DD was associated with younger age and tracheostomy. Unplanned 90-day readmissions were due to medical setbacks (96.7% of cases) and occurred in 53.7% and 45.0% of new and existing patients, respectively.CONCLUSIONS: DD and related costs are primarily associated with shortage of HCN and predominantly affect patients new to HCN. Medical setbacks are the most common causes of unplanned 90-day readmissions. Increasing the availability of home care nurses or postacute care facilities could reduce costly hospital length of stay.