DeWitt P K, Jansen M T, Ward S L, Keens T G
Division of Neonatology and Pediatric Pulmonology, Childrens Hospital, Los Angeles 90027.
Chest. 1993 May;103(5):1560-5. doi: 10.1378/chest.103.5.1560.
Home care for ventilatory-assisted children improves psychosocial development and reduces medical costs compared with hospital care; yet, many ventilator-assisted children remain hospitalized for lengthy periods of time after they have achieved medical stability. To identify factors that contributed to a delay in hospital discharge from the time medical stability was achieved, we reviewed the records of 54 ventilator-assisted children (age 4.6 +/- 5.9 [SD] years at discharge) who were discharged from the hospital on a regimen of home mechanical ventilation. The length of the hospitalization from which the ventilator-assisted children were initially discharged on the ventilator was 172 +/- 161 days (range, 2 to 756). The time from medical stability to discharge was 118 +/- 144 days (range, 2 to 724), or 73 percent +/- 29 percent of the total hospitalization. Fifty-one ventilator-assisted children were discharged to their natural parents' homes, and three were discharged to foster care. Once ventilator-assisted children were medically stable, it took 99 +/- 141 days for third-party payers to approve home care funding, and only 48 +/- 87 days to be discharged once funding was approved. For the 27 ventilator-assisted children with public funding, it took 184 +/- 177 days for home care funding approval, compared with 52 +/- 43 days for the 27 ventilator-assisted children with private funding (p < 0.001). Parent training took only 52 +/- 65 days. It took 369 +/- 334 days (range, 44 to 711 days) to find placement for the three ventilator-assisted children who were placed in medical foster care. In summary, ventilator-assisted children often remained hospitalized for prolonged periods of time, after they were medically stable, for nonmedical reasons. The greatest obstacle to hospital discharge was seeking approval for home care funding and for arranging out-of-home placement. Public funding agencies took significantly longer to approve home care funding than private insurance agencies.
与住院治疗相比，对需要通气辅助的儿童进行家庭护理可改善其心理社会发展并降低医疗成本；然而，许多需要通气辅助的儿童在病情稳定后仍需长时间住院。为了确定从病情稳定到出院延迟的相关因素，我们回顾了54名接受家庭机械通气治疗后出院的通气辅助儿童（出院时年龄为4.6±5.9[标准差]岁）的记录。这些通气辅助儿童最初因使用呼吸机而住院的时长为172±161天（范围为2至756天）。从病情稳定到出院的时间为118±144天（范围为2至724天），占总住院时间的73%±29%。51名通气辅助儿童出院后回到亲生父母家中，3名被送往寄养家庭。一旦通气辅助儿童病情稳定，第三方支付机构需要99±141天来批准家庭护理资金，而资金获批后只需48±87天即可出院。对于27名获得公共资金的通气辅助儿童，家庭护理资金获批需要184±177天，而27名获得私人资金的通气辅助儿童则需要52±43天（p<0.001）。家长培训仅需52±65天。为3名被安置在医疗寄养家庭的通气辅助儿童找到安置点需要369±,334天（范围为44至711天）。总之，通气辅助儿童在病情稳定后，常因非医疗原因而长时间住院。出院的最大障碍是寻求家庭护理资金的批准和安排院外安置。公共资金机构批准家庭护理资金的时间比私人保险公司长得多。
