Department of Health Sciences, Lund University, Lund, Sweden.
Pediatrics and Adolescent Medicine, The Juliane Marie Centre, The University Hospital, Copenhagen Rigshospitalet, Copenhagen, Denmark.
Acta Paediatr. 2019 Aug;108(8):1515-1520. doi: 10.1111/apa.14704. Epub 2019 Jan 18.
This paper presents an implementation study following previous research including a randomised controlled trial (RCT) of hospital-based home care (HBHC), referring to specialist care in a home-based setting. The aim was to evaluate whether the effects sustained when rolled out into wider practice.
In 2013-2014, 42 children newly diagnosed type 1 diabetes were included in the study at a university hospital in Sweden and followed for two years. Measurements of child safety, effects of services, resource use and service quality were included. Descriptive statistics were used to present the results and then discussed in relation to the same intervention of HBHC previously evaluated in an RCT.
Shorter in-hospital stay was partially implemented but increased support after discharge by the diabetes nurse was not. The results indicated that the implemented HBHC was equally effective in terms of child outcomes two years from diagnosis but less effective in terms of parents' outcome. The results furthermore indicated that the quality of services decreased.
The suggested overall conclusion was that the implemented HBHC services were safe but had become less effective, at least in relation to the HBHC provided under controlled circumstances.
本研究延续了先前的研究，包括一项基于医院的家庭护理（HBHC）的随机对照试验（RCT），指的是在家庭环境中提供专业护理。目的是评估当推广到更广泛的实践中时，这些效果是否能持续。
2013-2014 年，瑞典一所大学医院纳入了 42 名新诊断为 1 型糖尿病的儿童进行研究，并随访了两年。测量了儿童安全、服务效果、资源利用和服务质量。采用描述性统计方法来呈现结果，然后根据之前在 RCT 中评估的相同 HBHC 干预措施进行讨论。
住院时间缩短部分得到实施，但糖尿病护士出院后的支持并未增加。结果表明，从诊断后两年来看，实施的 HBHC 在儿童结局方面同样有效，但在父母结局方面效果较差。结果还表明，服务质量下降。
总的结论是，实施的 HBHC 服务是安全的，但至少在对照条件下提供的 HBHC 方面，其效果已经降低。
