Pediatric Hospital Discharges to Home Health and Postacute Facility Care

Berry, Jay G.; Hall, Matt; Dumas, Helene M.; Simpser, Edwin; Whitford, Kathleen; Wilson, Karen M.; O’Neill, Margaret; Mittal, Vineeta; Agrawal, Rishi; Dribbon, Michael; Haines, Christopher J.; Traul, Christine; Marks, Michelle; O’Brien, Judith A.

doi:10.1001/jamapediatrics.2015.4836

Cited by 63 publications

(59 citation statements)

References 22 publications

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“…A recent study of the utilization of postacute services in children found that almost one-half of pediatric patients discharged from the hospital from acute care hospital settings are neonates. 2 This study also noted that home health services seem to be infrequently and variably used in children compared with adults, even when assessing use in children with multiple chronic conditions and technology assistance. In addition, significant state-to-state utilization disparities exist across the United States.…”

Section: Introductionmentioning

confidence: 62%

“…These differences lead to inconsistent provision of home care services across states. 2 The increasing outsourcing of care to Medicaid managed care organizations has exacerbated problems with home health care services because of a number of factors that include dilution of pediatric expertise, limited provider networks, burdensome procedures for prior authorization, and potential payments at less than state Medicaid rates. Eligibility criteria for EPSDT services are not uniformly interpreted, particularly when essential treatments required by a child (eg, home care, hospice care) differ from or exceed those routinely covered for adults by private insurers and Medicare.…”

Section: Problem Statementmentioning

confidence: 99%

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Financing of Pediatric Home Health Care

Simpser

Hudak

2017

Pediatrics

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Pediatric home health care is an effective and holistic venue of treatment of children with medical complexity or developmental disabilities who otherwise may experience frequent and/or prolonged hospitalizations or who may enter chronic institutional care. Demand for pediatric home health care is increasing while the provider base is eroding, primarily because of inadequate payment or restrictions on benefits. As a result, home care responsibilities assumed by family caregivers have increased and imposed financial, physical, and psychological burdens on the family. The Patient Protection and Affordable Care Act set forth 10 mandated essential health benefits. Home care should be considered as an integral component of the habilitative and rehabilitative services and devices benefit, even though it is not explicitly recognized as a specific category of service. Pediatric-specific home health care services should be defined clearly as components of pediatric services, the 10th essential benefit, and recognized by all payers. Payments for home health care services should be sufficient to maintain an adequate provider work force with the pediatric-specific expertise and skills to care for children with medical complexity or developmental disability. Furthermore, coordination of care among various providers and the necessary direct patient care from which these care coordination plans are developed should be required and enabled by adequate payment. The American Academy of Pediatrics advocates for high-quality care by calling for development of pediatric-specific home health regulations and the licensure and certification of pediatric home health providers.

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Section: Introductionmentioning

confidence: 62%

Section: Problem Statementmentioning

confidence: 99%

Financing of Pediatric Home Health Care

Simpser

Hudak

2017

Pediatrics

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“…Results showing poorer outcomes in Hispanic patients are also consistent with past literature demonstrating health care disparities in Hispanics. Previous studies have shown that Hispanic ethnicity is associated with increased odds of hospitalization for an ambulatory care sensitive condition and decreased use of home care or facilities in pediatric patients. Further, Hispanic ethnicity is associated with higher mortality rate in patients with other respiratory diseases (eg, CF) and in those undergoing surgical procedures (eg, congenital heart surgery repair) .…”

Section: Discussionmentioning

confidence: 99%

Pseudomonas aeruginosa and post-tracheotomy bacterial respiratory tract infection readmissions

et al. 2017

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Objective Identify risk factors for readmission due to a bacterial tracheostomy-associated respiratory tract infection (bTARTI) within 12 months of discharge after tracheotomy. Design/Methods We performed a retrospective cohort study of 240 children who underwent tracheotomy and were discharged with tracheotsomy in place between 1/1/2005 and 6/30/2013. Children with prolonged total or post-tracheotomy length of stay (LOS), less than 12 months of follow-up, or who died during the index hospitalization were excluded. Readmission for a bTARTI (e.g., pneumonia, tracheitis) treated with antibiotics, as ascertained by manual chart review, was the outcome variable. We used multivariate logistic regression to identify the independent association between risk factors and hospital readmission for bTARTI within 12 months. Results At index hospitalizations for tracheotomy, the median admission age was 5 months [interquartile range (IQR) 2–43 months] and median LOS was 73 days (IQR 43–121 days). Most patients were of Hispanic ethnicity (n=162, 68%) and were publicly insured (n=213, 89%). Nearly half (n=112, 47%) were discharged on positive pressure mechanical ventilation. Many (n=103, 43%) were admitted for bTARTI within 12 months of discharge. Only Hispanic ethnicity [adjusted odds ratio (AOR) 2.0; 95% confidence interval (CI): 1.1–3.9; p=0.03)] and acquisition of Pseudomonas aeruginosa between tracheotomy and discharge from index hospitalization (AOR 3.2; 95% CI: 1.2–8.3; p=0.02) were independently associated with increased odds of bTARTI readmission, while discharge on gastrointestinal pro-motility agents was associated with decreased risk (AOR=0.4; 95% CI: 0.2–0.8; p=0.01). Conclusions Hispanic ethnicity and post-tracheotomy acquisition of Pseudomonas aeruginosa during initial hospitalization are associated with bTARTI readmission.

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“…41 Additional attention to the involvement and ability of postdischarge clinicians, including primary, rehabilitation, and home care providers, to assist the children with their recovery and health optimization after acutecare discharge may be warranted. 42 Future efforts to standardize this planning into discharge care might have an effect on reducing unnecessary hospital readmissions after spinal fusion in CMC.…”

Section: Figurementioning

confidence: 99%