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JAMA Pediatr. 2016 Apr;170(4):326-33. doi: 10.1001/jamapediatrics.2015.4836.

Pediatric Hospital Discharges to Home Health and Postacute Facility Care: A National Study.

Author information

1
Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts2Franciscan Hospital for Children, Boston, Massachusetts.
2
Children's Hospital Association, Overland Park, Kansas.
3
Franciscan Hospital for Children, Boston, Massachusetts.
4
St Mary's Healthcare System for Children, Bayside, New York.
5
Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland, Ohio.
6
Children's Hospital Colorado, University of Colorado, Aurora.
7
Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
8
University of Texas Southwestern Medical Center and Children's Medical Center Dallas.
9
Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
10
Children's Specialized Hospital, New Brunswick, New Jersey.

Abstract

IMPORTANCE:

Acute care hospitals are challenged to provide efficient, high-quality care to children who have medically complex conditions and may require weeks or months for recovery. Although the use of home health care (HHC) and facility-based postacute care (PAC) after discharge is well documented for adults, to our knowledge, little is known for children.

OBJECTIVE:

To assess the national prevalence of, characteristics of children discharged to, and variation in use across states of HHC and PAC for children.

DESIGN, SETTING, AND PARTICIPANTS:

Retrospective analysis of 2,423,031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years from the nationally representative Agency for Healthcare Research and Quality Kids' Inpatient Database.

MAIN OUTCOMES AND MEASURES:

Discharges to HHC (eg, visiting or private-duty home nursing) and PAC (eg, rehabilitation facility) were identified from Centers for Medicare and Medicaid Services Discharge Status Codes. We compared children's characteristics (eg, race/ethnicity and number of chronic conditions) by discharge type using generalized linear regression.

RESULTS:

The median age of participants was 3 years (interquartile range, 0-13 years), and 45.6% were female. Of 2,423,031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years, 122,673 discharges (5.1%) were to HHC and 26,282 (1.1%) were to PAC facilities. Neonatal care was the most common reason (44.5%, n = 54,589) for acute care hospitalization with discharge to HHC. Nonneonatal respiratory, musculoskeletal, and trauma-related problems, collectively, were the most common reasons for discharge to PAC (42.9%, n = 11,275). When compared with PAC, more discharges to HHC had no chronic condition (34.4% vs 18.0%, P < .001) and fewer discharges to HHC had 4 or more chronic conditions (22.5% vs 37.7%, P < .001). In multivariable analysis, Hispanic children were less likely to use PAC (0.8% vs 1.1%; odds ratio [OR], 0.9 [95% CI, 0.8-0.9]) or HHC (3.3% vs 5.5%; OR, 0.8 [95% CI, 0.7-0.8]) compared with other children. Children with 4 or more chronic conditions compared with no chronic conditions had a higher likelihood of HHC use (11.0% vs 4.4%; OR, 2.9 [95% CI, 2.8-3.0]) and PAC (3.9% vs 0.8%; OR, 4.5 [95% CI, 4.3-4.9]). After case-mix adjustment, there was significant (P < .001) variation across states in HHC (range, 0.4%-24.5%) and PAC (range, 0.4%-4.9%) use.

CONCLUSIONS AND RELEVANCE:

Home health care and PAC use after discharge for hospitalized children is infrequent, even for children with multiple chronic conditions. It varies significantly by race/ethnicity and across states. Further investigation is needed to assess reasons for this variation and to determine for which children HHC and PAC are most effective.

[Indexed for MEDLINE]

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