Pediatric Home Research Articles

Advance care planning and the parental geographical background in pediatric palliative home care: a retrospective chart review

The relevance to acknowledge the parental migration history in pediatric palliative care is widely recognized. However, its influence on integral parts of advance care planning (ACP) is unknown. In this non-interventional cohort study, we aimed at identifying systematic differences between pediatric palliative patients with varying parental countries of origin regarding medical orders for life-sustaining treatment and the location of patients’ death. Two hundred eighty-eight pediatric cases in an ambulant pediatric palliative care setting in Germany were retrospectively analyzed using multinomial logistic regression models. Agreements on medical orders for life-sustaining treatment (MOLST) differed significantly between patients with varying parental countries of origin. Full code orders for life-sustaining treatment were made more often in Turkish families than in German families. There were no significant associations between the patients’ location of death and the parental countries of origin. However, confounder-analysis revealed a strong association between the patients’ underlying disease and the orders for life-sustaining treatment as well as the location of death.Conclusions: Even this study indicates that the parental geographical background as an important sociocultural aspect might have an impact on ACP decisions for children and adolescents with life-limiting conditions, other factors as the patients’ underlying disease can be more crucial for decision making in pediatric palliative care. The reason for the differences found might lay in cultural preferences or barriers to appropriate care. The inclusion of sociocultural aspects in decision-making is crucial to guarantee culture-sensitive, patient-centered pediatric palliative care.What is Known:• Decision making processes in pediatric palliative care are influenced by various cultural and religious norms.• So far, there is little knowledge about tangible differences with regard to end-of-life care decisions according to the geographical background of parents.What is New:• End-of-life care decisions varied significantly with the parental country of origin.• Other factors as the underlying disease may be more crucial for decision making in pediatric palliative care.

In-the-moment ratings on the Early Relational Health Screen: A pilot study of application in home visiting and primary care.

Early infant-parent interaction sets a critical foundation for young children's well-being, and evidence regarding the protective role of secure early relationships has led to increased interest in effective screening and promotion of early relational health in pediatric primary care and home visiting settings. We report findings from two pilot studies conducted in the United States that describe the reliability and validity of a relational health screening tool, the Early Relational Health Screen (ERHS), implemented in two different contexts: an innovative model of relational health promotion in pediatric primary care (Study 1) and an Infant Mental Health Home Visiting (IMH-HV) model (Study 2). Across both studies, a trained clinician rated the ERHS following real-time observation of interaction (i.e., "in-the-moment" ratings). Reliability was assessed by comparing "in-the-moment" ERHS ratings to subsequent coding of the same interaction from video by an independent evaluator. In addition, Study 2 data permitted evaluation of the validity of "in-the-moment" ERHS ratings. Results from both studies indicated reliability of "in-the-moment" ERHS ratings. In addition, Study 2 clinician "in-the-moment" ratings were associated with maternal depression and ratings of child-parent interaction derived from a separateobservational task coded by independent evaluators using a different well-validated research-based measure. Discussion highlights the potential of the ERHS as a screening, promotion, and prevention tool that may be feasibly administered by providers across pediatric primary care and home visiting settings.

Telehealth sleep labs: bringing pediatric polysomnography home.

Telehealth sleep labs: bringing pediatric polysomnography home.

Strengths, Weaknesses, Threats, and Opportunities a Pediatric Home Care Program in Covid 19 Virus Pandemic: A Qualitative Study

Covid 19 has made a huge difference in all aspects of life, especially in care and treatment. Hospitalization is limited because of infected family members and fear of getting Covid 19 has limited. The purpose of this study is to analyze the existing conditions based on the SWOT analysis for the home care program for children in Coronavirus crisis. This study is a qualitative study with a conventional content analysis approach. Participants were 18 nurses, physicians, and faculty members, selected based on their willingness to participate in the study and through purposeful sampling. Two specialized panels and 10 presence and in-presence interview sessions were held to collect data. Then, the data were analyzed using SWOT analysis. Four main categories were emerged of the study including: (a) need for a legal protocol, (b) mutual fear of Covid-19, (c) self-responsibility in Corona, and (d) team working approach in the program development. In addition, solutions based on the SWOT analytical were suggested. The results of the study showed that it is necessary to develop a formal protocol, along with self-responsibility, and a program based on the needs of the community and the Covid crisis incorporating the team opinion.

“Home Sweet Home”: A Pediatric Palliative Home Transport Guide for Rural and Under-Resourced Areas (FR239)

“Home Sweet Home”: A Pediatric Palliative Home Transport Guide for Rural and Under-Resourced Areas (FR239)

Telehealth-supported level 2 pediatric home polysomnography.

The gold standard for diagnosis of pediatric obstructive sleep apnea (OSA) is level 1 polysomnography (PSG). At our centre, some children are selected for unattended level 2 home sleep apnea testing (HSAT) with telehealth support, and we sought to review this home service. A retrospective audit was conducted from 2013 to 2020. All level 2 HSAT reports in children aged 5-18 years referred for suspected OSA were analyzed. American Academy of Sleep Medicine-compliant portable PSG acquisition equipment with electroencephalogram was used. The primary outcome was the proportion of technically successful tests achieved, and of these, the percentage with potential underestimation of diagnostic category. Secondary outcomes included sleep quality and parental acceptance by nonvalidated service-specific questionnaire. Data were analyzed using descriptive and inferential statistics. χ2 tests were used for categorical variables. There were 233 (139 male, 59.6%) patients studied between 2013 and 2020 (7 years). The mean age was 10.8 (standard deviation 3.6) years. Sixty-seven patients (28.8%) had comorbidities. Technically successful studies were obtained in almost 90% (209/233) and failed studies occurred in just over 10% (24/233). One failed study still achieved a diagnosis. There was no significant difference between failed studies set up by hospital-in-the-home nurses compared with sleep scientists (P = .2). Overall, an accurate diagnosis was made in 80% (167/209) of patients, with potential for underestimation in 20% (42/209). Six hours or more of sleep was obtained in 89.5%. Parental questionnaires revealed 89.3% perceived high-level care, 91% perceived increased convenience, and 76% perceived good/excellent telehealth support. Telehealth-supported pediatric HSAT achieves technical success in almost 90% of patients investigated for OSA, with 89.5% achieving ≥ 6 hours sleep duration and excellent family acceptability. Griffiths A, Mukushi A, Adams A-M. Telehealth-supported level 2 pediatric home polysomnography. J Clin Sleep Med. 2022;18(7):1815-1821.

Impact of lockdown of Covid-19 pandemic on home injuries of children

Background: Due to the social isolation imposed by the COVID-19 pandemic, children have been forced to stay at home for extended periods of time. Besides the disease itself growing globally, this pandemic has inflicted many other healthcare problems. This study aims to look at the impact of the COVID-19 pandemic on pediatric home injuries. Methods: It is a prospective descriptive study conducted over a 5-month period from January 20, 2020 to June 12, 2020 of all children aged 0 to 18 years consulting the pediatric medical emergency department of the children's hospital in Rabat for home injuries. Results: A total of 13616 patients were admitted during the period from January 20, 2020 to June 12, 2020. Among them, 296 children were admitted for home injuries representing 1.5% of the total admissions before the lockdown and 4.3% during the lockdown. The mean age of the patients was 4 years. Most home injuries occurred in the evening from 6 pm onwards. The most frequent home injuries were foreign body ingestions (33.2%), drug intoxications (16.9%), CO intoxications (16.6%), and caustic ingestions (13.6%). The average admission delay after the accident was 14 hours before and during containment. During the confinement, 82% of the children received in the emergency room required hospitalization for specialized care or monitoring, and 18% were treated at home. Conclusion: The social isolation imposed by the COVID-19 pandemic has caused an increase in pediatric home injuries requiring admission to our department. Governments and healthcare authorities should proactively implement appropriate intervention programs and better plan resources to prevent these home injuries during the lockdown.

Long-term Outcomes of Pediatric Tracheostomy Home Care in a Limited Resource Setting of Professional Home Nurse

Long-term outcomes of pediatric patients with a tracheostomy in developing countries where professional home nurse is not accessible has rarely been reported. We, therefore, investigated the prevalence and associating factors of long-term outcomes in these children. Retrospective chart review was conducted in 85 tracheostomized children who were discharged to home during January 2012 to December 2020. Tracheostomy home care was provided by caregivers who completed the tracheostomy home care program. Prevalence of unplanned readmission with acute respiratory problems within 30 days after the first hospital discharge was 17.6%. Lower respiratory tract infection (LRTI) after hospital discharge was found in 72.9% (median frequency of 1.0 episode/case/year). Among 80 children who had surveillance airway endoscopy, 46.3% demonstrated late tracheostomy-related airway complications. Independent factor associated with late tracheostomy-related airway complications was a follow-up period longer than 1 year. Decannulation success was found in 21.2%. Most of them had tracheostomy for their upper airway anomalies. The mortality rate was 7%. Most of them died from their underlying diseases. In conclusion, pediatric tracheostomy home care undertaken by caregivers is feasible in developing countries where home nurse is not available. The prevalence of unplanned readmission with acute respiratory problems within 30 days after hospital discharge and late tracheostomy-related airway complications were comparable with those reported in developed countries. However, we still had a high prevalence of post-tracheostomy LRTI which was a challenging problem that needed to be investigated and resolved.

Case Study: Achieving "Hands-On" Practice for Remote Family Caregivers and Homecare Nurses of Children with Medical Complexity.

Pediatric nursing expertise in home care requires continuous development and maintenance of competencies. Through the pandemic, practice of essential "hands-on" skills was enabled by delivery of training mannequins from hospital to home care and a shift to virtual education. Learners (n = 57) included family caregivers of children with medical complexity and nurses new to home care. Evaluation informed iterative design of the service and signalled "Connected Care on the Go!" as desirable (100% highly satisfied), feasible (100% easily implemented) and viable. Now a sustainable service, this nurse-led innovation promotes partnership across leaders, sectors and geographies to address specialized training needs in pediatric home care.

The Effect of Clinical Research by Community Pharmacists on the Medical Field -The Perspective of Scientists in the Community Can Improve a Patient's Circumstances

Our pharmacy, with a sterile dispensary, is a support center for home-care dispensing; we are actively participating in a regional collaboration in combination with medical treatment, nursing, and social care. We have supported about 1000 home care patients so far: most of these have been elderly people living at home, but roughly two dozen were pediatric patients. Although the primary diseases of the children varied, they shared in common both a high dependence on medicine, and great difficulty in moving them. With our pediatric patients, a caregiver had to be in constant attendance because the child's medical care was intermittent. In addition, at the pharmacy, due to the volume of medication for these pediatric patients, caregivers have had to wait a long time for prescription fulfillment, and often receive so much medicine they need a cart to carry it home. Through providing pharmacist-led home guidance on medicines, we are able to offer some support in the pharmacotherapy of children with extreme symptoms who remain under the supervision of a doctor from an advanced medical institution, even after returning home. Through my experience visiting both elderly people and children under home care, I have keenly realized the importance of a community pharmacist's research in improving pediatric formulation and home medical care systems. We must aim to reduce the burden of medication management for both patients and caregivers, and to improve a patient's "comprehensive quality of life, including (his or her) family".

Pediatric Practice Transformation and Long-Acting Reversible Contraception (LARC) Use in Adolescents.

Long acting reversible contraceptives (LARCs) are recommended as highly effective for adolescents. Although the uptake of LARCs has increased, overall use remains low due to barriers for both providers and patients. We evaluate whether pediatric medical home transformation, including implant placement in pediatrics, may increase LARC use or decrease adolescent pregnancy rates. Retrospective interrupted time-series analysis of adolescents ages 11 to 19 years at 2 pediatric practices in academically affiliated community health centers during 2005-2015. The intervention practice underwent medical home transformation including team-based care with family planning and health coaching, youth-friendly policies, and contraceptive implant placement. The control practice continued usual care. Differential changes in population event rates were evaluated using a segmented longitudinal regression model. The study population included 4946 adolescent females at the intervention practice and 1992 at the control practice. Following practice transformation, LARC use increased significantly more at the intervention practice compared to the control (1.73 versus 0.28 events per 1000 patients quarterly P=0.004). Pregnancy rate declined at both practices without temporal correlation to the LARC intervention. During the medical home transformation period, the intervention practice showed a greater decline in pregnancy rate, though this difference did not reach statistical significance (2.01 versus 0.81 events per 1000 patients quarterly P=0.090). Adolescents had higher LARC use where implant placement was offered within the pediatric practice as part of medical home transformation. Although LARC did not impact pregnancy rate, the process of practice transformation may have accelerated its decline through heightened adolescent health focus.

Pediatric Tele-Home Care Compared to Usual Care: Cost-Minimization Analysis.

BackgroundAlthough home hospitalization has been a well-known and widespread practice for some time in the adult population, it has not been the same case in the pediatric setting. Simultaneously, telemedicine tools are a facilitator of the change in the health care model, which is increasingly focused on home care. In a pioneering way in Spain, the in-home hospitalization program of the Hospital Sant Joan de Déu in Barcelona allows the child to be in their home environment at the time they are being monitored and clinically followed by the professionals. Besides being the preferred option for families, previous experience suggests that pediatric home hospitalization reduces costs, primarily thanks to savings on the structural cost of the stay.ObjectiveThe aim of this study is to compare the average cost of a discharge by tele–home care with the usual care and to analyze the main drivers of the differential costs of both care models.MethodsA cost-minimization analysis is conducted under a hospital’s perspective, based on observational data, and estimated retrospectively. A historical control group of similar patients in terms of clinical casuistry to children hospitalized at home was used for comparison.ResultsA 24-hour stay at the hospital costs US $574.19, while the in-home hospitalization costs US $301.71 per day, representing a saving of almost half (48%) of the cost compared to usual care. The main saving drivers were the personnel costs (US $102.83/US $284.53, 35.5% of the total), intermediate noncare costs (US $6.09/US $284.53, 33.17%), and structural costs (US $55.16/US $284.53, 19.04%). Home hospitalization involves a total stay 27.61% longer, but at almost half the daily cost, and thus represents a saving of US $176.70 (9.01%) per 24-hour stay.ConclusionsThe cost analysis conducted under a hospital perspective shows that pediatric tele–home care is 9% cheaper compared to regular hospital care. These results motivate the most widespread implementation of the service from the point of view of economic efficiency, adding to previous experiences that suggest that it is also preferable from the perspective of user satisfaction.

Transition to adult dental care from a pediatric hospital dental home for patients with special health care needs.

This study describes patients with complex Special Health Care Needs (SHCN) transitioning from a pediatric hospital clinic dental home to adult care and evaluates effectiveness of transition practices. Demographics, medical/behavioral complexity, and documentation of transition processes were collected for patients graduated from the service in 2018/2019. An invitation to complete a survey assessing transition was sent to patients/guardians≥14 months after the final visit. Seventy-nine patients graduated and 94% required accommodation for SHCN: 47% medical, 42% medical + behavioral, and 5% behavioral only. Of 63 eligible patients/guardians, 29 completed surveys. While 90% of surveyed patients had established some/all adult medical care, only 41% completed a dental visit, and less than 28% established a dental home. Medical/behavioral complexity, payer, and time since graduation did not impact having a visit. This study found ineffectiveness of departmental protocol for transition to adult dental homes for patients with SHCN. Developing an optimal transition process is complex and will require collaboration of all stakeholders. Introducing transition in early teen years, tracking progress at subsequent visits, assessing patient readiness, summarizing history for receiving providers, and verifying transition are elements of medical transition programs that should be included in dental transitions.

Curare la bronchiolite a casa: una Review sistematica

Bronchiolitis is the leading cause of pediatric hospitalizations Home hospitalization (HAH) provides hospital-level care at home, reducing the pressure on hospital admissions. In the study analyzed, aimed at reviewing the feasibility, acceptability and safety of HAH for bronchiolitis and assessing the cost impact on hospitals and society, 10 studies that met the inclusion criteria were analyzed. Home oxygen therapy (HOT) was used in all studies, and HOT was found to be feasible in terms of utilization (70%-82%) and successful completion. In the reviewed studies, 7 adverse events (0.6%) with no mortality were reported in 1.257 patients. On costs, the studies showed some savings, although only costs to hospitals were analyzed. In conclusion, there is evidence to support HOT as feasible, acceptable, and safe. Cost-effectiveness evidence remains limited. Further studies are needed to understand the relevant impact of HAH with regard to oxygen therapy, nasogastric feeding support, and remote infant monitoring.

A Medical Financial Partnership in a Pediatric Medical Home

The Volunteer Income Tax Assistance (VITA) program is an underutilized free taxpreparation service that directly addresses poverty by maximizing tax refunds. A pediatric medical home (PMH) with an embedded VITA site provides an excellent opportunity for a medical-financial partnership. We sought to assess the knowledge, attitudes, and practices of caregivers of children who used a PMH after embedding a VITA site. We found that a PMH-VITA site was a convenient, trusted, useful, and potentially tax-filing behaviorchanging intervention. Importantly, most caregivers who did not use the PMH-VITA site had no knowledge of availability of free tax filing services but would consider using one the following year. Improved marketing is needed to increase utilization in our target population.

Allocation of Pediatric Home Care Nursing Hours: The Minnesota Experience.

Despite an increasing demand for pediatric home care nursing, there is no comprehensive or universal standard of care for prescribing pediatric home care nursing hours based on a child's medical complexity. Adoption of a qualification tool (QT) to allocate home care nursing hours based on the medical complexity of a child may mitigate inequality in access to care and improve the patient and family experience. A QT, developed in Minnesota, recommends home care nursing hours based on the level of medical complexity and need for skilled nursing interventions. Four hypothetical case studies demonstrate the use of the QT to calculate recommended nursing hours. To validate the tool, a survey of discharge planners found a percentage difference in calculated hours of 4.1, 5.7, 11.2, and 24.9 in the four case studies. Discharge planners rated the usability of the QT as favorable with a score of 3.6 on a Likert scale of 5. The recommended nursing hours prescribed for families, based on the QT, was perceived as meeting the needs of the child by 56% and 42% of surveyed parents and home care nurses (HCNs), respectively. The need for additional nursing hours was expressed by 33% and 50% of parents and nurses, respectively. In general, HCNs' assessment of allocated nursing hours paralleled that of parents. Further refinement and adoption of a standardized QT to allocate home care nursing hours may improve access and outcomes for children requiring home care nursing.

Effective Factors on Implementation of Pediatric Home Care Program Amid COVID 19 Pandemic: Facilitators and Barriers.

Background:Home care service is considered as comprehensive care for children with chronic disease or COVID-19. This study aimed to investigate the factors affecting the implementation of a home care nursing program for such children in 2019–2020.Materials and Methods:A descriptive-analytical study was conducted with 198 nurses working in pediatric wards of selective hospitals of Isfahan University of Medical Sciences. The data were collected through an author-administered questionnaire with 44 questions. The questionnaire was designed in two parts. Part one involved gathering the demographic data of the participants. Facilitating and barrier factors of the implementation of the care were prioritized and examined in part two by using the Likert scale in both the individual and the organizational domains. The data were analyzed using the mean frequency and paired t test.Results:The mean (SD) score of individual and organizational facilitating factors were 65.65 (16.24) and 65.98 (11.29), respectively, and the mean (SD) score of the organizational barriers was 82.04 (14.36), which was significantly higher than the mean score (SD) of the individual barriers of 57.94 (14.82) (t197 = 21.32, p < 0.05). The most important individual facilitating factor (53.82%) was “respectful communication with the family,” and the most important organizational facilitator (80.40%) was “Physicians’ support of the nurses.”Conclusions:Organizational factors were the most significant barriers. Therefore, the findings of this study will help policymakers in the program implementation.

Current Supply Status of Medical Consumables in Pediatric Home Care and Challenges for the Future : a Questionnaire-based Survey

Current Supply Status of Medical Consumables in Pediatric Home Care and Challenges for the Future : a Questionnaire-based Survey

Questionnaire on the Current Status of Pediatric Home Dental Care in Kanagawa Prefecture

Questionnaire on the Current Status of Pediatric Home Dental Care in Kanagawa Prefecture

Regional Differences in the Current Status of Pediatric Home Nursing Stations

Regional Differences in the Current Status of Pediatric Home Nursing Stations