Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
J Pediatr. 2023 Oct;261:113347. doi: 10.1016/j.jpeds.2022.12.043. Epub 2023 Feb 10.
To compare the characteristics and healthcare use of children with medical complexity who receive paid certified nursing assistant (CNA) care by a family member (family CNA) and by a traditional nonfamily member (nonfamily CNA).
This was retrospective cohort study of children who received CNA care through Colorado's Medicaid paid family caregiving program between 2017 and 2019 by a home healthcare agency. We compared patient characteristics between the family CNA and nonfamily CNA groups. A multivariable Poisson regression model was used to compare hospitalization rates (days in the hospital per year), adjusting for patient age patient sex, nursing care, and complex chronic condition.
Of 861 patients, 79% (n = 680) received family CNA care and 21% (n = 181) received nonfamily CNA care. Patient demographics and hospitalization did not differ between the groups, although patients who had family CNAs were less likely to receive additional nursing-level care (42% vs 60%, P < .01). Family and nonfamily CNA caregivers had similar characteristics, except that family CNA caregivers had substantially better 3-year retention (82% vs 9%, P < .01) despite lower average hourly pay ($14.60 vs $17.60 per hour, P < .01). Hospitalizations were rare (<10% of patients). In the adjusted model, patients who received family CNA care experienced 1 more hospitalized day per year, compared with patients who received nonfamily CNA care (P < .001).
Paid family caregivers provided CAN-level care to children with medical complexity with a greater employee retention compared with nonfamily CNA caregivers, with marginally different hospitalization rates using a family-centered approach. This model may help address workforce shortages while also providing income to family caregivers.
比较接受家庭成员（家庭 CNA）和传统非家庭成员（非家庭 CNA）付费认证护士助理（CNA）护理的患有医疗复杂性的儿童的特征和医疗保健利用情况。
这是一项回顾性队列研究，对象为 2017 年至 2019 年期间通过家庭医疗保健机构接受科罗拉多州医疗补助付费家庭护理计划中 CNA 护理的儿童。我们比较了家庭 CNA 和非家庭 CNA 组之间的患者特征。使用多变量泊松回归模型比较了住院率（每年住院天数），并调整了患者年龄、患者性别、护理和复杂慢性病。
在 861 名患者中，79%（n=680）接受家庭 CNA 护理，21%（n=181）接受非家庭 CNA 护理。两组患者的人口统计学特征和住院情况无差异，但接受家庭 CNA 护理的患者接受额外护理级别的护理的可能性较小（42%比 60%，P<0.01）。家庭和非家庭 CNA 护理人员具有相似的特征，除了家庭 CNA 护理人员的 3 年保留率明显较高（82%比 9%，P<0.01），尽管平均时薪较低（每小时 14.60 美元比 17.60 美元，P<0.01）。住院情况很少见（<10%的患者）。在调整后的模型中，与接受非家庭 CNA 护理的患者相比，接受家庭 CNA 护理的患者每年多住院 1 天（P<0.001）。
与非家庭 CNA 护理人员相比，接受付费家庭护理人员提供 CNA 级护理的患有医疗复杂性的儿童的员工保留率更高，采用以家庭为中心的方法，住院率略有不同。这种模式可能有助于解决劳动力短缺问题，同时为家庭护理人员提供收入。
