儿童医疗复杂性的家庭保健可用性和出院延迟。

Home Health Care Availability and Discharge Delays in Children With Medical Complexity.

机构信息

Children's Minnesota, Minneapolis, Minnesota;

Pediatric Home Service, Roseville, Minnesota.

出版信息

Pediatrics. 2019 Jan;143(1). doi: 10.1542/peds.2018-1951. Epub 2018 Dec 3.

DOI:10.1542/peds.2018-1951

PMID:30509929

Abstract

UNLABELLED

: media-1vid110.1542/5849572914001PEDS-VA_2018-1951 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.

摘要

目的

越来越多的儿科住院天数归因于依赖技术的儿童。儿科家庭护理（HCN）短缺对该人群住院时间延长和再入院率增加的影响尚未得到充分记录。

方法

我们对出院后接受家庭健康护理的患有医疗复杂性的儿童进行了为期 12 个月的多地点前瞻性研究。我们研究了以下两个队列：首次出院到家庭护理的新患者和从医院出院到以前建立的家庭护理的现有患者。使用改良的延迟工具对原因、延迟出院（DD）天数和计划外 90 天再入院进行分类。

结果

68.5%的 54 名新患者和 9.2%的 131 名现有患者出现 DD。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，有 1454 例（91.9%）直接归因于缺乏 HCN 供应。DD 与年龄较小和气管造口术有关。计划外 90 天再入院是由于医疗挫折（96.7%的病例），新患者和现有患者的再入院率分别为 53.7%和 45.0%。