Video-conferencing and remote vital signs monitors were used to provide Tele-HomeCare (THC) to children with complex healthcare needs. This paper reports the effects of THC on the health-related quality of life (QoL) of children and their parents, and the Impact on Families (IoF). A total of 63 children and their parents were enrolled in a THC trial in which they received traditional home care services and up to 6 weeks of THC. A reference group of 16 children and their parents was also recruited and received only traditional home care services. All parents completed QoL questionnaires for both their child and themselves, and the IoF scale. Complete data were available for 50 THC participants: 34 of these had no readmissions and 16 experienced multiple admissions. The reference group contained 10 participants who received standard community care. All three groups experienced similar improvements in quality of life at the time of their discharge to home after which their QoL remained stable. There were no significant differences in the IoF scores. THC is an effective clinical service that supports the transition from hospital to home at a time when the children continued to have complex care needs. Furthermore, improvements in QoL were observed for these families that were similar to those of families whose children had less intensive care needs. Moreover, the improvements were sustained beyond the termination of the THC service and were not associated with additional burden on families.
The delivery of health care is often segmented into sectors. In Canada, hospital care has traditionally been distinct from community care, and thus the transition of patients across sectors has been challenging. This paper focuses on the systematic development of an integrated model of care for children, for the purpose of smoothing the transition from hospital to home. The new service model uses emerging telecommunications technology to link hospital care providers to patients at home and is termed "telehomecare" (THC). Independent models of THC were developed for three sites across Canada through semistructured interviews and focus groups. Participants included health care providers and administrators from the hospital and community, and patient families. The resulting models were compared using content analysis to determine whether there was a core model of THC that was generalisable across Canada. A core model of THC was identified that includes the use of videoconferencing to enable the integration of hospital- and community-based care to support patients during the initial stages of the transition to home. Each site also articulated unique characteristics in their service model that were related to the nature of their health care delivery system and patient population. This paper describes the core model of transitional care, presents a synopsis of each of the three models, and compares the models. THC provides opportunities to address limitations in the current system and to improve upon equity of access to quality care for children making the transition from hospital to home.
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