Abstract
ObjectiveTo assess the determinants of ED use in paediatric patients enrolled in an Integrated Paediatric Home Care (IPHC) program.MethodsA retrospective study was conducted using administrative databases on a cohort of patients enrolled in an IPHC program between January 1st, 2012, and December 31st, 2017, in Northern Italy. ED visits that occurred during the IPHC program were considered. Data were collected considering sociodemographic, clinical and organizational variables. A multivariable stepwise logistic regression analysis was performed. The dependent variable to identify possible associations was ED visit.ResultsA total of 463 ED visits occurred in 465 children, with an incidence rate of 1. The risk of ED visits significantly increased among children involved in the IPHC program after hospital discharge (OR 1.94). Additionally, the risk of ED visits increased significantly as the duration of IPHC increased (OR 5.80 between 101 and 200 days, to OR 7.84 between 201 and 300 days, OR 12.54 between 301 and 400 days and OR 18.67 to more than 400 days).ConclusionThe overall results represent a practical perspective to contribute improving both the service quality of IPHC and reducing low acuity and improper ED use.
Highlights
The emphasis on Paediatric Home Care (PHC) services has increased internationally due to the growing number of children who rely on long-term medical needs and have had complex conditions since birth [1], the availability of High-Technology interventions outside the hospital and scientific advances in the understanding of insurgent complications [2,3,4]
PHC is provided through two organizational models of care according to the level of intensity, complexity and duration of the care intervention: a) programmed home or ambulatory care in which paediatricians care for patients at their home following a schedule and plan hospital visits according to the patient’s chronic condition; b) integrated PHC (IPHC) consisting of different services in response to medium-/ high-complexity medical, nursing and/or social health needs [9]
The results showed that the Akaike information criterion (AIC) and Bayesian information criterion (BIC) were not comparable because of the differences in the underlying populations, and we could not resort to analysis of variance (ANOVA) because of different degrees of freedom in the models
Summary
The emphasis on Paediatric Home Care (PHC) services has increased internationally due to the growing number of children who rely on long-term medical needs and have had complex conditions since birth [1], the availability of High-Technology interventions outside the hospital and scientific advances in the understanding of insurgent complications [2,3,4]. In Italy, PHC programs were introduced in 2001 They are defined as a modality of health and social assistance delivered in the patient’s home in a continuous and integrated way by paediatricians and other healthcare professionals (e.g., medical specialists, nurses, therapists, social workers) [8]. PHC is provided through two organizational models of care according to the level of intensity, complexity and duration of the care intervention: a) programmed home or ambulatory care in which paediatricians care for patients at their home following a schedule and plan hospital visits according to the patient’s chronic condition; b) integrated PHC (IPHC) consisting of different services in response to medium-/ high-complexity medical, nursing and/or social health needs [9]. The IPHC service is available from 8AM to 8PM on weekdays, and by on-call medical service on weekend
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