Home–hospital care for children with acute illnesses: A 2‐year follow‐up study

Abstract

Aim Procedures normally performed in the hospital setting are increasingly delivered as part of hospital at home (HAH) programmes. The aim of this study is to describe the procedures and diseases treated during the first 2 years of a new paediatric HAH programme. Methods This is a retrospective, observational study conducted in the HAH programme of Niño Jesús Children's Hospital (Spain). We included demographic data, diagnosis and procedures delivered to patients admitted to the HAH programme from November 2018 to November 2020. Results There were 935 admissions of 833 patients. The median age was 5 years (interquartile range 2.3–9.5). Seventy‐five percent of patients were previously healthy. The most frequent illnesses were acute infections (37%) (e.g. complicated appendicitis and ENT, genitourinary, skin and soft tissue infections) and acute respiratory diseases (17.3%) (e.g. asthma, bronchiolitis and pneumonia). Thirty‐six percent of admissions underwent nocturnal polysomnography. The median length of stay was 4 days (SD 4.9 days). Eight percent of the episodes studied required care in the emergency department due to condition worsening (55.3%) and problems with devices (36.1%). Hospital readmission was required in 5.6% of cases, 42.4% of which later resumed care in the HAH. The estimated daily cost of HAH is 330.65 euros, while the hospital per‐day costs of polysomnography, asthma and endovenous therapy are 1899.24, 1402.5, and 976.26 euros. Ninety percent of families reported a high level of satisfaction. Conclusions Paediatric HAH programmes are a feasible, cost‐effective alternative to hospital care. Further studies should compare the evolution of patients treated in the traditional hospital setting and those in HAH.

Methods to Reduce Cost of Treatment in Childhood Bone and Joint Infection

“…Publications that described the success of hospital in the home (involving community nurse administration of IV antibiotics) cite potential cost savings from earlier discharge 33,44 . This may be of value in particularly complex or chronic cases where prolonged intravenous antibiotics are preferred by the treating team.…”

“…Of note, studies that report hospitalization cost based on administrative data sets are considered at risk of selection bias because of inaccurate classification of diseases in hospital coding systems. Loss of follow-up and missing data were common issues, and only 9 studies explicitly mention guideline adherence 30,31,36,37,39,40,42,44,51 .…”

Putting equity at the forefront as telehealth advances: A hospitalist perspective

“…Additionally, patient satisfaction was very high with 99% of families scoring a 4 or 5 on 5-point Likert scale. 12 As healthcare continues to transform, providers must be cognizant of threats to caregiver burden that are posed by providing acute care to patients at home. Health systems should perform social screenings to identify risks to families being considered for a HaH care plan.…”

“…In this study, only 5% of children were transitioned from home to the hospital, primarily due to worsening of disease, and almost half of them transitioned back to HaH after improvement with no significant adverse events reported. Additionally, patient satisfaction was very high with 99% of families scoring a 4 or 5 on 5‐point Likert scale 12 . As healthcare continues to transform, providers must be cognizant of threats to caregiver burden that are posed by providing acute care to patients at home.…”

Outcome and complications of outpatient parenteral therapy in pediatric emergency utilizing only peripheral vascular access

“…27 Hospital daily cost in pediatric in-patient service was reported to be from 976.26-1,899.24 Euros, depending on the reason for admission. 40 If we apply the lowest cost to our OPT 3663 total days, the amount saved was around 3,576,040.38 Euros during the 15-month study period.…”