Pediatric Home Health Research Articles

Guidelines for Pediatric Home Health Care

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Caregivers' Experiences at Home With a Ventilator-Dependent Child

With advancing technology and transformation in health care delivery, more chronically ventilator-dependent children are being discharged to home. Pediatric home health care aims to increase the quality of life of patients and families, decrease cost and duration of hospital stay, and promote community participation in health care delivery. The authors aimed to describe and identify the qualitatively different experiences of primary caregivers who support ventilator-dependent children at home. Through phenomenographic inquiry 17 primary caregivers described their experiences through interviews that were later analyzed using accepted qualitative methods. Seven categories of description and an outcome space were identified, with findings highlighting the unique experience of this group and providing insight into their personal, social, and collective experiences. Outcomes reveal the significant and distinctive nature of understanding and have implications for clinical practice development, health education, policy formulation, social support, and future research in pediatric home health care.

Going Home: What NICU Nurses Need to Know about Home Care

Pediatric home health care enables patients to be at home with their families in settings that bring them joy, comfort, and the security we all feel when we are at home. There is also a feeling, no matter how small, that the parents have some control over what is happening to their child. Infants with multiple needs require in-depth discharge planning. There are the physical and health concerns of the preterm infant and the potential complications that he could still develop. Parent teaching is vital for the successful transition from hopital to home. When the neonatal discharge nurse is aware of what difficulties the parents and the patient might face at home, her teaching can be tailored to meer the specific needs of these vulnerable, complicated infants. This article discusses the discharge planning process, which begins upon admission to the neonatal intensive care unit, as well as common problems encountered by many premature infants discharged home.

Financing of Pediatric Home Health Care

In certain situations, home health care has been shown to be a cost-effective alternative to inpatient hospital care. National health expenditures reveal that pediatric home health costs totaled $5.3 billion in 2000. Medicaid is the major payer for pediatric home health care (77%), followed by other public sources (22%). Private health insurance and families each paid less than 1% of pediatric home health expenses. The most important factors affecting access to home health care are the inadequate supply of clinicians and ancillary personnel, shortages of home health nurses with pediatric expertise, inadequate payment, and restrictive insurance and managed care policies. Many children must stay in the NICU, PICU, and other pediatric wards and intermediate care areas at a much higher cost because of inadequate pediatric home health care services. The main financing problem pertaining to Medicaid is low payment to home health agencies at rates that are insufficient to provide beneficiaries access to home health services. Although home care services may be a covered benefit under private health plans, most do not cover private-duty nursing (83%), home health aides (45%), or home physical, occupational, or speech therapy (33%) and/or impose visit or monetary limits or caps. To advocate for improvements in financing of pediatric home health care, the American Academy of Pediatrics has developed several recommendations for public policy makers, federal and state Medicaid offices, private insurers, managed care plans, Title V officials, and home health care professionals. These recommendations will improve licensing, payment, coverage, and research related to pediatric home health services.

Hematology/oncology care map use in a pediatric home health care setting

Hematology/oncology care map use in a pediatric home health care setting

Hematology/oncology care map use in a pediatric home health care setting

Hematology/oncology care map use in a pediatric home health care setting

Are All Children Equal? An Analysis of the Predictive Value of Selected Pediatric Characteristics of the Referral of Children to Pediatric Home Health Services

To examine the predictive value of selected pediatric characteristics of the referral of children to pediatric home health services (PHHS). No empirical studies to date have evaluated the criteria used to determine the need for PHHS or if disparities in the referral of children to PHHS occur. Randomly selected hospital records of 557 children discharged from one pediatric hospital between October 1999 and September 2000 were examined. Sequential logistic regression was used to calculate the odds of being referred to PHHS based on age, race or ethnicity, number of legal guardians in the household, and the number of technological devices at discharge. Insurance was excluded as a predictor because 97% of the study sample was insured. Only the number of technological devices at discharge added predictive value (chi(2)[DF = 3, N= 557]= 42.023, P<0.001) to the SLR model. There was no evidence of disparities in referral. To ensure availability and equitable access to PHHS, nurses must actively participate in the discharge planning process for all children.

Guidelines for Pediatric Home Health Care Manual

Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional: August 2003 - Volume 21 - Issue 8 - p 563

Hematology/Oncology Care Map Use in a Pediatric Home Health Care Setting

Hematology/Oncology Care Map Use in a Pediatric Home Health Care Setting

Hematology/Oncology Care Map Use in a Pediatric Home Health Care Setting

Hematology/Oncology Care Map Use in a Pediatric Home Health Care Setting

Home bowel preparation for elective colonic procedures in children: Cost savings with quality assurance and improvement

Background/Purpose: The current health care environment pressures providers to lower cost and demands quality care that is measured by outcomes and patient satisfaction. Most insurers will not approve bed days for in-hospital preoperative bowel preparations for elective colorectal procedures. This policy does not take into account that infants and children are unable to tolerate large volumes of enteral preparation, which adversely affects outcome because of an inadequate preparation. This report describes a prospective evaluation of a standard home bowel preparation regimen utilizing local and regional home health care agency support.Methods: For an elective colorectal procedure, pediatric patients underwent a home bowel preparation using GoLYTELY (100 mL/kg) via a nasogastric tube infused over 4 hours by a pediatric home health nurse trained in this technique. During the bowel preparation, the nurse educated the family members about the service and performed physiological monitoring to insure safety. At the completion of the preparation, any unusual events were transmitted to the staff surgeon for further instructions. Our initial 30 patients were treated by our hospital home health agency personnel to insure safety. Since then, 41 additional bowel preparations have been performed by statewide agencies.Results: Seventy-one patients underwent complete home bowel preparation (45 boys; 26 girls). The age range was 3 months to 9 years (average, 5 months). There was one complication caused by incorrect mixing of GoLYTELY causing gastrointestinal cramping. All 71 home bowel preparations were recorded as good at the time of the colorectal procedure by the staff pediatric surgeon. The average cost for home bowel preparation was $300 in network, and $350 out of network. This compares with an inpatient hospital day cost of greater than $800 ($36,000 savings).Conclusions: This technique offers the pediatric surgeon an opportunity to maintain a high standard of quality care while using home health agency personnel to minimize cost. This program is safe, effective, and associated with a good outcome and a high degree of family satisfaction.

Pediatric home care: Reimbursement and cost benefit analysis

Home care has been described as the fastest growing component of personal health care spending, and pediatric home care as the fastest growing segment of the home care field. Because of the continued progress in pediatric medicine and advances in technology, a growing population of children with complex chronic and terminal conditions can be cared for at home. A growing subspecialty in pediatric health care is delivering services for infants and children with HIV infection or AIDS and those born to mothers addicted to drugs or alcohol. This article describes the reimbursement and cost-benefit issues surrounding pediatric home health care, with particular attention to the HIV/AIDS pediatric population.

Measuring Access To Care: Improving Information For Policymakers

Measuring Access To Care: Improving Information For Policymakers

An introduction to pediatric home health care.

To provide an overview of the delivery of home health care services to pediatric patients. All pediatric patients. Institution-based nurses are integral in making referrals for home health care services and assuring home health care agencies have the needed information for providing seamless services. Institution-based nurses are the first line in the transition to home and are key members in making the transition happen without unnecessary difficulty for the child and family. This article presents pragmatic information about home health care agencies and how they operate so that institution-based nurses can maximize the benefit their pediatric patients receive from home health care.

Pediatric home health care in King County, Washington.

Pediatric home health care is one of the fastest growing segments of our health care system. However, our knowledge of the extent and quality of the services provided in this field is generally limited. Despite this shortcoming, pediatric health care providers are increasingly expected to participate in the home health care of their patients. To describe the agencies and services that constitute pediatric home health care in a large metropolitan setting. During the summer of 1995, home health care agencies in King County, WA, were surveyed if they had provided any pediatric services within the preceding 6 months. The agencies were queried about their characteristics and services provided, as well as referral and reimbursement sources. Survey data were supplemented by interviews with agency and state health personnel. Fourteen (88%) of the 16 agencies providing pediatric home health care services completed the survey. Agencies were predominantly for-profit, free-standing, and in business fewer than 10 years. Although there were uniform licensing requirements for agencies, no pediatric-specific regulations existed. In addition, many agencies lacked internal methods to ensure the provision of quality pediatric care. Eighty percent of all pediatric home health care services were provided by only 5 agencies. For intermittent (acute) services, agencies served approximately 450 children per month. The average number of visits per child was two, with 40% receiving only one visit. Services included skilled nursing (60%), infusion (27%), and respiratory therapy (9%). Maintenance (chronic) home health care services, for 156 chronically ill children, were provided almost exclusively by skilled nursing for an average of 9 hours per patient per day. The majority of referrals to agencies (75%) originated from health care providers, although a small number came from insurance companies or individual families. Reimbursement for intermittent care services was divided among commercial insurance (35%), captitated contracts (35%), and Medicaid (20%). In contrast, 90% of reimbursement for the chronically ill was from Medicaid. In King County, WA, pediatric home health care is predominantly an unregulated, for-profit industry, with most agencies having little actual experience in pediatric home health care. In addition, the unique features of pediatric home health care necessitate both a greater understanding of this field and the consideration of more specific guidelines.

Integration of Dietitian Services in a Hospital-Based Pediatric Home Health Care Department

LEARNING OUTCOME: To describe how limited dietitian hours can be used to provide nutrition services for the hospital's Home Health Care patientsSince July 1994 a dietitian liaison from the hospital's Nutrition Department has been a member of the Home Health Care (HHC) team. This dietitian acts as a resource to HHC staff and organizes weekly patient case conferences for enteral and total parenteral nutrition (TPN) patients. The dietitian liaison also assisted HHC in the development of a nutrition screening assessment used prior to hospital discharge. Weekly case conferences include the dietitian liaison, a HHC nursing supervisor or metabolic nurse, and a HHC pharmacist. Each person gathers information from appropriate primary care providers and the family, before a round table style discussion and documentation process. Patients are systematically reviewed so that all enteral feeding patients are discussed at least every 6 months and all TPN patients at least every month.Because of the dietitian's involvement, the HHC Department has been able to meet and exceed the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards. Prior to this program, only about 75% (57/73) of the HHC patients receiving enteral feedings and/or TPN had any involvement with a dietitian, even on an inconsistent basis. As a result of the case conferences, patients have been identified who appear to be using less product than prescribed, HHC services have been terminated or nursing visits restarted in a more timely manner, and complete nutrition reassessments have been initiated to ensure that the patient continues to receive the desired intake. When HHC field nurses were surveyed in March 1996, all nurses responding indicated they had consulted with a hospital dietitian in the past 6 months. These nurses also indicated an interest in written guidelines or periodic inservices on nutrition related topics. A repeat survey of the nurses a year later and documentation of patients identified for further nutrition consultation are tools for evaluating how well the dietitian is used as a resource within the HHC Department.

Pediatric Home Health: The Need for Physician Education

Home health represents a spectrum of exciting practice possibilities for the pediatrician. Care in the home can be provided for acute, intermediate, or long-term health conditions. An acute infection can be treated at home with physician or nurse visits; a relapse of leukemia or chronic infection (osteomyelitis) can be managed at home with intermittent drug therapy. Home care can involve high technology (mechanical ventilators), low technology (assistive mobility aids), or no technology. Home care can be provided only by family members or with supplemental support from neighbors, friends, personal attendants, or professionals on an intermittent or continuous care basis. For the physician, home care may involve discharge planning, postdischarge care oversight (telephone, documentation), or just "an old-fashioned house call."

Minimizing the trauma: Development of a pediatric trauma home health care program

Traumatic injuries in children account for a large percentage of physician and emergency de partment visits, as well as inpatient hospital admissions. Changes in the health care environ ment, as well as the special needs of children and families, are the incentives for the develop ment of a comprehensive home care program. This article describes the program components and educational preparation of staff. Key words: home health nursing, pediatric trauma

Negotiating nurse-patient authority in pediatric home health care.

In this qualitative study, pediatric home health nurses described the solitary, ambiguous, and unprogrammed nature of home health nursing. As employees of the family, the nurses in this study found it necessary to negotiate their work tasks and working conditions with family members. In describing the meaning of their work, the nurses emphasized differences between hospital and home health nursing with regard to their authority for care decisions, methods of child discipline, parental control of care, and innovations of nursing routines and interventions. Characteristics of pediatric home nursing are identified in order for these to be communicated to prospective home care nurses, to pediatric nurse educators, and to home health managers. With knowledge of these characteristics, a new home health nurse will be better prepared to negotiate shared patient care responsibilities with the client's family.

Alleged failure to treat a technology- dependent infant in the home health care setting: A risk management case study

This article presents an actual case history of a situation that was mismanaged and re sulted in a very large settlement for the patient who was severely impaired neurologically as a result of poor crisis intervention. The case study acts as a resource for pediatric home health care providers to develop standards from a risk management perspective. It also points out to each of us our individual responsibility to be prepared to provide safe, high quality care in the home.