Boston Children's Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care, United States; Harvard Medical School, United States.
Boston Children's Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care, United States; Harvard Medical School, United States.
Healthc (Amst). 2017 Mar;5(1-2):23-28. doi: 10.1016/j.hjdsi.2016.04.002. Epub 2016 May 11.
Describe utilization and satisfaction in a specialty integrated care program for children with severe, chronic respiratory insufficiency (CRI).
Enrollees of the Critical Care, Anesthesia, Perioperative Extension (CAPE) and Home Ventilation Program.
Children with CRI received home visits, care coordination, and "on-demand" 24/7 access to physicians. Program activity and outcomes were recorded for 3 years using an adapted Care Coordination Measurement Tool© version. Parents completed the Consumer Assessment of Healthcare Providers and Systems (CAHPS). Patient characteristics, program activity, clinical outcomes, utilization, and satisfaction were summarized using descriptive statistics.
CAPE provided care for 320 patients from 2012 to 2014 with a median of 7 encounters per year. Neuromuscular (n=132, 41%), chronic lung disease (n=37, 12%), and congenital heart disease (n=13, 4%) represented the majority of underlying conditions. Services included 905 home, 504 clinic, and 3633 telephone encounters, of which 43.6% included a care coordination activity. CAHPS (n=102) revealed that 92.1% (n=93) of children had at least one non-urgent (i.e., routine) visit and nearly two-thirds (64.7%, n=66) reported the need for urgent or emergency care. Overall, parents were highly satisfied with CAPE, with a mean satisfaction rating of 9.3 (±1.3) out of 10. Most parents reported that the CAPE team understood the child's (96.0%, n=95) and family's day-to-day life (86.9%, n=86).
When given open access to an intregated care program, children in our highly complex population required a median of 7 encounters per year. We believe that this experience is scalable and may inform other organizations contemplating similar services.
描述严重慢性呼吸功能不全（CRI）儿童的综合专科护理计划的利用情况和满意度。
Critical Care、Anesthesia、Perioperative Extension（CAPE）和家庭通气计划的参与者。
患有 CRI 的儿童接受家庭访问、护理协调以及对医生的“按需”24/7 访问。使用经过改编的 Care Coordination Measurement Tool©版本，在三年内记录计划活动和结果。父母完成医疗保健提供者和系统消费者评估（CAHPS）。使用描述性统计方法总结患者特征、计划活动、临床结果、利用情况和满意度。
CAPE 在 2012 年至 2014 年期间为 320 名患者提供护理，每年中位数为 7 次就诊。神经肌肉疾病（n=132，41%）、慢性肺部疾病（n=37，12%）和先天性心脏病（n=13，4%）是最常见的基础疾病。服务包括 905 次家庭、504 次诊所和 3633 次电话访问，其中 43.6%包括护理协调活动。CAHPS（n=102）显示，92.1%（n=93）的儿童至少有一次非紧急（即常规）就诊，近三分之二（64.7%，n=66）报告需要紧急或紧急护理。总体而言，家长对 CAPE 非常满意，平均满意度评分为 10 分中的 9.3（±1.3）。大多数家长表示，CAPE 团队了解孩子（96.0%，n=95）和家庭的日常生活（86.9%，n=86）。
当给予综合护理计划的开放接入时，我们的高度复杂人群中的儿童每年需要中位数为 7 次就诊。我们相信这种经验是可扩展的，并可能为其他考虑类似服务的组织提供信息。
