Evans Adele K
Departments of Clinical Sciences and Pediatrics University of Central Florida College of Medicine, Nemours Children's Hospital Orlando Florida USA.
Laryngoscope Investig Otolaryngol. 2025 Jun 18;10(3):e70167. doi: 10.1002/lio2.70167. eCollection 2025 Jun.
BACKGROUND/CONTEXT: Home health nursing is considered critical to transition to at-home care after pediatric tracheostomy. This diminishing resource contributes a barrier to at-home care. Telemedicine (Bluetooth wireless technology for monitoring vital signs, Wi-Fi data transfer to a centralized monitoring center for alarm response) could add support for families during this transition. This manuscript compares a retrospective evaluation of observed hospital costs to modeled estimates for a Pediatric Tracheostomy Remote Home Monitoring Program (PTRHMP): equipment alarm monitoring, call-to-home confirmation, and a centralized database of critical information for Emergency Medical Services (EMS) dispatch.
(1) Cost of Care Cohort analysis of in-patient cost of care for pediatric tracheostomy patients using retrospective chart review. (2) Modeled cost estimates using a financial proforma developed by experts in the field. (3) Comparative Analysis of Cost of Care Cohort versus PTRHMP proforma. (4) Potentially avoidable Adverse Event analysis.
Thirty-three candidates met inclusion criteria for the Cost of Care Cohort Analysis. Average LOS was 31.6 days longer than target LOS, was influenced by average number of caregivers ( < 0.0001) and by age at tracheostomy placement ( = 0.038; 1), and averaged ($17,000/day billed, $3000/day payments received) 10 times the cost estimated for the PTRHMP proforma ($285 per patient-day).
The widespread adoption of a Pediatric Tracheostomy Remote Home Monitoring Program (PTRHMP) appears to be technologically and financially tenable at one tenth the cost of in-patient care. Patients under the age of 2 at tracheostomy placement may represent a separate subgroup for analysis. An implementation study is required to determine the level of safety compared to currently available conditions.
2-Cohort Study.
背景/情境：家庭健康护理被认为对于小儿气管切开术后过渡到家庭护理至关重要。这种资源的减少对家庭护理构成了障碍。远程医疗（用于监测生命体征的蓝牙无线技术、将Wi-Fi数据传输到集中监测中心以进行警报响应）可以在此过渡期间为家庭提供支持。本手稿比较了对观察到的医院成本的回顾性评估与小儿气管切开术远程家庭监测项目（PTRHMP）的模型估计：设备警报监测、致电家庭确认以及用于紧急医疗服务（EMS）调度的关键信息集中数据库。
（1）使用回顾性病历审查对小儿气管切开术患者的住院护理成本进行护理成本队列分析。（2）使用该领域专家制定的财务预测表进行模型成本估计。（3）护理成本队列与PTRHMP预测表的成本比较分析。（4）潜在可避免不良事件分析。
33名候选人符合护理成本队列分析的纳入标准。平均住院时间比目标住院时间长31.6天，受平均护理人员数量（<0.0001）和气管切开术时年龄（=0.038；1）影响，平均（每日计费17,000美元，每日收到付款3000美元）是PTRHMP预测表估计成本（每位患者每天285美元）的10倍。
小儿气管切开术远程家庭监测项目（PTRHMP）的广泛采用在技术和经济上似乎是可行的，成本仅为住院护理的十分之一。气管切开术时年龄在2岁以下的患者可能代表一个单独的分析亚组。需要进行一项实施研究以确定与当前可用条件相比的安全水平。
2 - 队列研究。
