Discharged Pediatric Patients Infrequently Receive Home Health, Facility-Based Post-Acute Care, Study Finds

Among pediatric patients, hospital discharges to both home health and facility-based post-acute care are infrequent, according to a new study. The study, partially funded by AHRQ, used data from AHRQ’s Kids’ Inpatient Database to assess the national prevalence of both types of post-discharge care among children. Researchers analyzed records from more than 2.4 million acute care pediatric (0–21 years old) discharges in 2012 and found that 5 percent of discharges were to home health care and 1.1 percent were to facility-based post-acute care. Neonatal care was the most common reason for discharge to home health care (46 percent). Researchers also found that both home health and facility-based post-acute care varied widely by race/ethnicity and across states, and that Hispanic children were less likely to use either type of post-acute care. More research is needed to understand these variations and to determine for which children home health and facility-based post-acute care are most effective, researchers concluded. The study, “Pediatric Hospital Discharges to Home Health and Post-Acute Facility Care: A National Study,” and the abstract were published in the February 22 issue of JAMA Pediatrics.

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

2016 Feb 22. doi: 10.1001/jamapediatrics.2015.4836. [Epub ahead of print]

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

Berry JG1, Hall M2, Dumas H3, Simpser E4, Whitford K5, Wilson KM6, O'Neill M7, Mittal V8, Agrawal R9, Dribbon M10, Haines CJ10, Traul C5, Marks M5, O'Brien J3.

Author information

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.