Factors Associated With De-Hospitalization of Children and Adolescents With Complex Chronic Condition

Abstract

Objective: To assess the factors associated with the de-hospitalization of children and adolescents with complex chronic condition. Methods: This cross-sectional and retrospective study investigated a sample of children and adolescents admitted to the Dehospitalization Training Unit, from January 2012 to December 2017. Data were collected by consulting medical records and patient record books, from November 2018 to June 2019. The length of stay in the unit, de-hospitalization, readmissions, frequency and cause of death, age, sex, diagnosis, place of residence, number of caregivers and kinship, and use of devices were studied. The chi-square test was used to verify the association between the dependent variable (de-hospitalization) and the independent variables (age, sex, place of residence, use of devices, and clinical diagnosis). Results: A total of 93 patient records were analyzed, 37.6% aged between 7 months and 2 years old, 58.1% boys, 95.7% used tracheostomy, 92.5% gastrostomy, and 71% invasive mechanical ventilation. Hypoxic-ischemic encephalopathy was the diagnosis of 40.3% of the sample. Average hospitalization time was 288 ± 265 days; 60.2% were hospitalized between 31 days and one year, representing 50% of deaths. Of those de-hospitalized, 76.3% were discharged to the Ventilatory Assistance Homecare Program. De-hospitalization was associated with the child or adolescent's place of residence (p=0.027) and use of ventriculoperitoneal shunt (p=0.021). Conclusions: This study identified that de-hospitalization may be associated with the place of residence of the child or adolescent, with the highest number of discharges to the state capital, and non-dehospitalization when using ventricular-peritoneal shunt.

Processo de desospitalização e atenção domiciliar no Brasil e seus fatores associados

“…Tais cuidados exigem um conhecimento ampliado dos profissionais de saúde e familiares. Entretanto, nem sempre eles apresentam os saberes necessários e muitas vezes não estão qualificados adequadamente para exercer o cuidado adequado com as crianças (Klein et al, 2021;Novais et al, 2021;Sato et al, 2022).…”

“…Nesse sentido, faz-se necessária a intervenção de uma equipe multiprofissional de saúde, com uma alta hospitalar planejada, a qual leva em consideração diversos aspectos, como: o desejo da família de levar a criança para o domicílio; o preparo e capacitação dos familiares/cuidadores; as condições clínicas da criança; os encaminhamentos legais e o acesso a benefícios e auxílios; o acesso aos materiais e equipamentos que essa criança necessitará, bem como a estruturação da rede de atenção à saúde que essa família acessará após a alta hospitalar (Klein et al, 2021;Novais et al, 2021;Sato et al, 2022).…”

“…A interdisciplinaridade proporciona uma visão biopsicossocial e se torna uma prática fundamental para o fortalecimento da integralidade do Sistema Único de Saúde (Klein et al, 2021;Novais et al, 2021;Sato et al, 2022).…”