Journal Article•
Efficiency and Cost of a Hospital-Based Medical Home: Children with Special Healthcare Needs
01 Jan 2009-Florida public health review (University of South Florida College of Public Health (USF COPH))-Vol. 6, Iss: 1, pp 85-92
TL;DR: Each of the cost-effectiveness measures were found to be significantly lower post enrollment in the Hospital-Based Medical Home Model.
Abstract: The current study examined two years of pre-post hospital utilization data (the number of emergency room visits, number of unanticipated hospitalizations, and length of stay (LOS)) among forty-nine medically complex children to determine the efficiency and cost effectiveness of a comprehensive Hospital-Based Medical Home Model. Friedman nonparametric analysis was used to examine the pre-post differences for the non-normal distribution. Each of the cost-effectiveness measures (number of emergency room visits, number of unanticipated hospitalizations, and LOS) were found to be significantly lower post enrollment in the Hospital-Based Medical Home Model. Florida Public Health Review, 2009; 6, 85-92. Int tro od
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TL;DR: Although positive, the evidence supporting comprehensive hospital-based programs for children with special health care needs is restricted primarily to nonexperimental studies of children with categorical diseases and is limited by inadequate outcome measures.
Abstract: Objective To examine the effectiveness of hospital-based comprehensive care programs in improving the quality of care for children with special health care needs. Data Sources A systematic review was conducted using Ovid MEDLINE, CINAHL, EMBASE, PsycINFO, Sociological Abstracts SocioFile, and Web of Science. Study Selection Evaluations of comprehensive care programs for categorical (those with single disease) and noncategorical groups of children with special health care needs were included. Selected articles were reviewed independently by 2 raters. Data Extraction Models of care focused on comprehensive care based at least partially in a hospital setting. The main outcome measures were the proportions of studies demonstrating improvement in the Institute of Medicine's quality-of-care domains (effectiveness of care, efficiency of care, patient or family centeredness, patient safety, timeliness of care, and equity of care). Data Synthesis Thirty-three unique programs were included, 13 (39%) of which were randomized controlled trials. Improved outcomes most commonly reported were efficiency of care (64% [49 of 76 outcomes]), effectiveness of care (60% [57 of 95 outcomes]), and patient or family centeredness (53% [10 of 19 outcomes). Outcomes less commonly evaluated were patient safety (9% [3 of 33 programs]), timeliness of care (6% [2 of 33 programs]), and equity of care (0%). Randomized controlled trials occurred more frequently in studies evaluating categorical vs noncategorical disease populations (11 of 17 [65%] vs 2 of 16 [17%], P = .008). Conclusions Although positive, the evidence supporting comprehensive hospital-based programs for children with special health care needs is restricted primarily to nonexperimental studies of children with categorical diseases and is limited by inadequate outcome measures. Additional high-quality evidence with appropriate comparative groups and broad outcomes is necessary to justify continued development and growth of programs for broad groups of children with special health care needs.
76 citations
TL;DR: The findings indicate that hospital-at-home for children is a good solution if the parents are well prepared and feel in control, and Norwegian policymakers should initiate more pilot testing of hospital- at- home for children.
Abstract: In recent decades, there has been a shift from hospitalisation to home care throughout the Western world, even for children. Hospital-at-home for children is in a developmental phase and represents a new service model in Norway. The aim of this pilot study conducted in a Norwegian healthcare setting was to explore how parents with a sick child experienced early hospital discharge and further care at home. The qualitative data are drawn from nine interviews with parents with a child admitted to hospital-at-home. Transcripts of interviews were analysed using a method of qualitative content analysis. In the analysis, Antonovsky's salutogenic perspective on how people cope in demanding life situations was applied. The results show that the parents experienced hospital-at-home as providing a calmer, more predictable family life compared to hospitalisation. They argued that good information and training in medical procedures prior to hospital discharge made hospital-at-home easier to master. The participants pointed out the importance of the professionals' competence and their ability to interact with the child and the parent. The certitude that they could return to the hospital at any time made them feel safe and in control. The parents associated hospital-at-home with a kind of normalisation of their family life. They had a prominent need for normalisation, and this was probably a motivation for agreeing to the hospital-at-home arrangement. The findings indicate that hospital-at-home for children is a good solution if the parents are well prepared and feel in control. In addition, certain structural conditions must be in place before this type of health care is established; there must be a certain volume of patients and the distance to the hospital must be clearly limited. Norwegian policymakers should initiate more pilot testing of hospital-at-home for children. Users and clinicians should be involved in establishing and evaluating these services.
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120 citations
TL;DR: Recommendations that urban caregiving families from 3 major ethnocultural backgrounds have for improving the care of children with chronic conditions indicate that further work needs to be done to deliver care that is, indeed, family centered and culturally sensitive.
Abstract: Background: Little research has been done on services and programs for children with chronic conditions and their families from the perspective of family caregivers from diverse cultural backgrounds. Objective: To identify recommendations that urban caregiving families from 3 major ethnocultural backgrounds have for improving the care of children with chronic conditions (ie, chronic illnesses and disabilities involving physical health impairments). Design: Qualitative, community-based study. Setting: General community. Participants: The volunteer convenience sample included 21 African American, 20 Hispanic, and 22 European American families from 2 midwestern cities who care for school-aged children with chronic conditions. Methods: In-home semistructured interviews were conducted with each child’s family caregivers. Content analytic techniques were used to identify and classify 275 recommendations from 63 families. Results: Families focused on the following 4 topics: (1) improving the quality of health care services; (2) decreasing barriers to services and programs; (3) improving the training that health care professionals, families, and the public receive about chronic conditions and their management; and (4) improving the quality and availability of community-based services. Families from all 3 ethnic groups had similar recommendations for improving services and programs; however, several African American and Hispanic families also suggested making information more culturally relevant and resources more accessible to families from diverse cultural backgrounds. Conclusions: The findings indicate that further work needs to be done to deliver care that is, indeed, family centered and culturally sensitive. Families’ recommendations provide information that health care professionals and policymakers can use to transform rhetoric about family-centered care into action. Arch Pediatr Adolesc Med. 1998;152:440-448
108 citations
TL;DR: Currently available data do not allow survival of the individual extremely low-birth weight or extremely premature infant to be predicted with clinically acceptable accuracy, and the provision of neonatal intensive care is not necessarily beneficial or justified merely because it affords some minimal chance of survival.
107 citations
"Efficiency and Cost of a Hospital-B..." refers background in this paper
...For example, advancements in neonatal intensive care services have led to considerable improvements in the survival of premature neonates (Lorenz, 2000)....
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TL;DR: The ability of children with asthma, their parents, and their physician to create a positive partnership, or treatment alliance, appears to have an important role in optimal asthma management.
Abstract: Objective: To examine the concept of treatment alliance in the care of adolescents with asthma. Methods: Measures of treatment alliance were obtained from 60 adolescents with severe, chronic asthma admitted to a tertiary care facility, their parents, and their asthma specialists at the referral center. Associations were examined between the alliance measures and multimeasure, multiagent data concerning family functioning and asthma treatment adherence and outcome. Results: Physicians’ reports of treatment alliance were associated with concurrent family functioning and asthma medication adherence, as well as with asthma treatment adherence and outcome in the year after the stay at the asthma center. Conclusions: As emphasized in the recently revised Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma (NHLBI, 1997), the ability of children with asthma, their parents, and their physician to create a positive partnership, or treatment alliance, appears to have an important role in optimal asthma management.
101 citations
TL;DR: Comprehensive follow-up care by experienced caregivers can be highly effective in reducing life-threatening illness without increasing costs among high-risk inner-city infants.
Abstract: ContextInner-city high-risk infants often receive limited and fragmented care,
a problem that may increase serious illness.ObjectiveTo assess whether access to comprehensive care in a follow-up clinic
is cost-effective in reducing life-threatening illnesses among high-risk,
inner-city infants.DesignRandomized controlled trial.Setting and ParticipantsA total of 887 very-low-birth-weight infants born in a Texas county
hospital between January 1988 and March 1996 and followed up in a children's
hospital clinic. One hundred four infants who became ineligible or died after
randomization but before nursery discharge were excluded from the analysis.InterventionsInfants were randomly assigned to receive routine follow-up care (well-baby
care and care for chronic illnesses; n = 441) or comprehensive care (which
included the components of routine care plus care for acute illnesses, with
24-hour access to a primary caregiver; n = 446).Main Outcome MeasuresLife-threatening illnesses (ie, causing death or hospital admission
for pediatric intensive care) occurring between nursery discharge and age
1 year, assessed by blinded evaluators from inpatient charts and state Medicaid
and vital statistics records; and hospital costs (estimated from department-specific
cost-to-charge ratios).ResultsComprehensive care resulted in a mean of 3.1 more clinic visits and
6.7 more telephone conversations with clinic staff (P<.001
for both). One-year outcomes were unknown for fewer comprehensive-care infants
than routine-care infants (9 vs 28; P = .001). Identified
deaths were similar (11 in comprehensive care vs 13 in routine care; P = .68). The comprehensive-care group had 48% fewer life-threatening
illnesses (33 vs 63; P<.001), 57% fewer intensive
care admissions (23 vs 53; P = .003), and 42% fewer
intensive care days (254 vs 440; P = .003). Comprehensive
care did not increase the mean estimated cost per infant for all care ($6265
with comprehensive care and $9913 with routine care).ConclusionComprehensive follow-up care by experienced caregivers can be highly
effective in reducing life-threatening illness without increasing costs among
high-risk inner-city infants.
94 citations