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Dumas HM, Hughes ML, O'Brien JE. Children dependent on respiratory support: A 10-year review from one pediatric postacute care hospital. Pediatr Pulmonol 2020; 55:2050-2054. [PMID: 32437015 DOI: 10.1002/ppul.24861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/17/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pediatric postacute care hospitals (PACH) provide long-term care for children with medical complexity including children dependent on respiratory support. Descriptions of PACH respiratory care populations and outcomes, however, remain under-reported. Our aim was to describe demographics, respiratory outcome, and longitudinal trend of children with respiratory support admitted to a single PACH in the United States. METHODS Using electronic records from 2009 to 2018, data were examined for all children dependent on respiratory support. Children were identified for inclusion using respiratory level of care classifications (type of support) as outlined in hospital policy. Outcome was defined as change in level from first admission to final discharge. Number of admissions by level and year during the study timeframe were analyzed. RESULTS There were 1423 admissions for 767 children requiring respiratory support during the study timeframe. Children with higher respiratory classification level (eg, mechanical ventilation) at initial admission had more admissions to PACH (P < .001) and longer length of stays (P < .001). From first admission to final discharge, there was a significant change (reduction) in respiratory level (z = -4.588, P < .001). An increase in the overall number of admissions for children with respiratory support during the study timeframe was noted, with the largest increase for children requiring the highest level of support. CONCLUSION There has been a consistent increase in the number of children requiring respiratory support at admission to PACH. Reduction in respiratory support with postacute care occurs but children admitted with a higher level of support stay longer and experience multiple admissions.
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Affiliation(s)
- Helene M Dumas
- Medical-Rehabilitation Research Center, Franciscan Children's Hospital, Boston, Massachusetts
| | - Mary Laurette Hughes
- Medical-Rehabilitation Research Center, Franciscan Children's Hospital, Boston, Massachusetts
| | - Jane E O'Brien
- Medical-Rehabilitation Research Center, Franciscan Children's Hospital, Boston, Massachusetts
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2
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Birnkrant DJ, Noritz GH. Is There a Role for Palliative Care in Progressive Pediatric Neuromuscular Diseases? The Answer is “Yes”! J Palliat Care 2019. [DOI: 10.1177/082585970802400406] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David J. Birnkrant
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Garey H. Noritz
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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O'Brien JE, Dumas HM, Fragala-Pinkham MA, Berry JG. Admissions to Acute Care Within 30 and 90 Days of Discharge Home From a Pediatric Post-acute Care Hospital. Hosp Pediatr 2017; 7:682-685. [PMID: 29025957 DOI: 10.1542/hpeds.2017-0039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Of all hospitalized children, those with medical complexity have the highest likelihood of hospital readmission. Post-acute hospital care could potentially help stabilize the health of these children. We examined the frequency of acute care hospital admissions after discharge home from a post-acute care hospital (PACH). METHODS A retrospective cohort analysis of 448 children with medical complexity discharged from a PACH from January 1, 2010, to December 31, 2015, with the main outcomes of acute care hospital readmissions 0 to 30 and 31 to 90 days after discharge home from a PACH. Demographic and clinical characteristics were compared between children with and without acute care readmission and between the 2 readmission groups. RESULTS Ninety-nine children (22%) had a readmission to the acute care hospital. Of these readmissions, 61 (62%) occurred between 0 and 30 days and 38 (38%) between 31 and 90 days after PACH discharge. A higher percentage of children readmitted had high medical severity (>3 systems involved or ventilator dependent) compared with children not readmitted (68% vs 31%, P = .04). No differences were found between children who were readmitted and those who were not by sex, race, payer, length of stay, or age at PACH discharge. Additionally, no differences were found between children readmitted within 30 days and children readmitted 31 to 90 days after PACH discharge. CONCLUSIONS The majority of children discharged home from a PACH do not require an acute care hospitalization within the first 3 months. Children with greater medical severity are readmitted more often than others.
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Affiliation(s)
- Jane E O'Brien
- Franciscan Hospital for Children, Boston, Massachusetts; and.,Children's Hospital, Boston, Massachusetts
| | - Helene M Dumas
- Franciscan Hospital for Children, Boston, Massachusetts; and
| | | | - Jay G Berry
- Franciscan Hospital for Children, Boston, Massachusetts; and.,Children's Hospital, Boston, Massachusetts
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Berry J, Wilson K, Dumas H, Simpser E, O'Brien J, Whitford K, May R, Mittal V, Murphy N, Steinhorn D, Agrawal R, Rehm K, Marks M, Traul C, Dribbon M, Haines C, Hall M. Use of Post-Acute Facility Care in Children Hospitalized With Acute Respiratory Illness. J Hosp Med 2017; 12:626-631. [PMID: 28786428 DOI: 10.12788/jhm.2780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recovery from respiratory illness (RI), a common reason for hospitalization, can be protracted for some children because of high illness severity or underlying medical complexity. OBJECTIVE We assessed which children hospitalized with RI are the most likely to use post-acute facility care (PAC) for recovery. METHODS Retrospective analysis of 609,800 hospitalizations for patients in 43 US children's hospitals between 2010- 2015 for RI, identified with the Agency for Healthcare Research and Quality Clinical Classification System. Discharge to PAC was identified using Centers for Medicare & Medicaid Services Discharge Status Codes. We compared patient characteristics by PAC use with generalized estimating equations. RESULTS There were 2660 (0.4%) RI hospitalizations resulting in PAC transfer (n = 2660, 0.4%). Discharges to PAC had greater percentages of technology assistance (83.2% vs 15.1%), neuromuscular chronic condition (57.5% vs 8.9%), and mechanical ventilation (52.7% vs 9.1%), 𝑃 < 0.001 for all. The highest likelihood of PAC use occurred with ≥11 vs no chronic conditions (odds ratio [OR] 11.7 [95% CI, 8.0- 17.2]), ≥9 vs no therapeutic medication classes (OR 4.8 [95% CI, 1.8-13.0]), and existing tracheostomy (OR 3.0, 95% confidence interval [CI], 2.6-3.5). Median (interquartile range [IQR]) acute-care length of stay (LOS) for children most likely to use PAC was 19 (8-56) days; LOS remained long (median 13 [6-41] days) for children with the same attributes (n = 9448) not transferred to PAC. CONCLUSIONS Children with RI who are most likely to use PAC have a high prevalence of multiple chronic conditions, multiple medications, and medical technology. Future investigations should assess the supply of PAC against the demand of hospitalized children with RI who might need it.
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Affiliation(s)
- Jay Berry
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Franciscan Children's Hospital, Boston, Massachusetts, USA
| | - Karen Wilson
- Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Helene Dumas
- Franciscan Children's Hospital, Boston, Massachusetts, USA
| | - Edwin Simpser
- St. Mary's Healthcare System for Children, Bayside, New York, USA
| | - Jane O'Brien
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Franciscan Children's Hospital, Boston, Massachusetts, USA
| | - Kathleen Whitford
- Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland, Ohio, USA
| | - Rachna May
- The Children's Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Vineeta Mittal
- UTSW Medical Center & Children's Medical Center Dallas, Dallas, Texas, USA
| | - Nancy Murphy
- Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Rishi Agrawal
- Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kris Rehm
- Monroe Carroll Jr., Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Michelle Marks
- Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland, Ohio, USA
| | - Christine Traul
- Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland, Ohio, USA
| | - Michael Dribbon
- Children's Specialized Hospital, New Brunswick, New Jersey, USA
| | | | - Matt Hall
- Children's Hospital Association, Overland Park, Kansas, USA
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O'Brien JE, Berry J, Dumas H. Pediatric Post-Acute Hospital Care: Striving for Identity and Value. Hosp Pediatr 2015; 5:548-551. [PMID: 26427924 DOI: 10.1542/hpeds.2015-0133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The landscape of hospital care for children is changing. Hospital clinicians are challenged to provide high-quality care to 2 increasingly complex groups of children: (1) healthy children admitted for high-severity acute illnesses or injury and (2) children admitted with lifelong, and often disabling, chronic conditions. Hospitalizations for both of these groups are becoming more prevalent, lengthy, and costly. In many situations, these children need weeks, or sometimes months, to recover from their illness or injury, with a sustained intensity of daily caregiving needs throughout their recovery period. Pediatric post-acute hospital care is a little-known and underused option in pediatric health care that could substantially help these children stabilize in a less restrictive and less costly environment than acute care hospitals can provide. In this commentary, we (1) propose the need and place for pediatric post-acute care hospitals along the continuum of care, (2) discuss the characteristics of children currently cared for in pediatric post-acute care hospitals, (3) suggest research opportunities and challenges, and (4) present issues related to the cost and value of pediatric post-acute care hospitals.
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Affiliation(s)
- Jane E O'Brien
- Franciscan Hospital for Children, Boston, Massachusetts, and Boston Children's Hospital, Boston, Massachusetts
| | - Jay Berry
- Franciscan Hospital for Children, Boston, Massachusetts, and Boston Children's Hospital, Boston, Massachusetts
| | - Helene Dumas
- Franciscan Hospital for Children, Boston, Massachusetts, and
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Abstract
On the basis of research evidence, (1)(2) numerous diseases and conditions can impair gas exchange, resulting in failure to meet the body's metabolic demands and leading to respiratory failure. On the basis of consensus, (1)(2)(7)(8)(9)(10) the clinical presentations of respiratory failure depend on the underlying cause and the level of hypoxemia and hypercapnia. Early diagnosis, close monitoring, and timely intervention are of utmost importance. On the basis of research evidence, (5)(14)(25) interventions range from noninvasive methods, such as close monitoring and supplemental oxygen, to full respiratory support with mechanical ventilation and in extreme cases even the use of extracorporeal membrane oxygenation.
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Affiliation(s)
- Phuong Vo
- Division of Pediatric Pulmonary and Allergy, Boston Medical Center, Boston, MA
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O'Brien JE, Dumas HM, Nash CM, Burke SA, Holson DC, Mast J, Pelegano J, Simpser EF, Traul C, Whitford K. Pediatric post-acute care hospital transitions: an evaluation of current practice. Hosp Pediatr 2014; 4:217-21. [PMID: 24986990 DOI: 10.1542/hpeds.2013-0105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES After discharge from an acute care hospital, some children require ongoing care at a post-acute care hospital. Care transitions occur at both admission to the post-acute care hospital and again at discharge to the home/community. Our objective was to report the current practices used during the admission to and discharge from 7 pediatric post-acute care hospitals in the United States. METHODS Participants from 7 pediatric post-acute care hospitals completed a survey and rated the frequency of use of 20 practices to prepare and support children and their families during both admission to the hospital and at time of discharge to the home/community. For consistency with existing literature, practices were grouped into 4 previously reported categories: assessment, communication, education, and logistics. Descriptive statistics were used to report the frequency of use within practices and between hospitals. RESULTS Only 2 of 10 admission practices and 3 of 10 discharge practices were reportedly "always" used by all hospitals. Assessment and communication practices were reported to be more frequently used (57%-100% of the time) than education and logistic procedures. Between hospitals, only the reported frequency of use of the discharge practices was statistically significantly different (P = .03). CONCLUSIONS Variability exists in transition practices among 7 post-acute care pediatric hospitals. This report is the first known to detail the frequency of use of admission and discharge practices for pediatric post-acute care hospitals in the United States.
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Affiliation(s)
| | | | - Carol M Nash
- Franciscan Hospital for Children, Boston, Massachusetts
| | - Sharon A Burke
- Children's Specialized Hospital, New Brunswick, New Jersey
| | | | - Joelle Mast
- Blythedale Children's Hospital, Valhalla, New York
| | | | | | - Christine Traul
- Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland, Ohio
| | - Kathleen Whitford
- Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland, Ohio
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Cardiorespiratory response during physical therapist intervention for infants and young children with chronic respiratory insufficiency. Pediatr Phys Ther 2013; 25:178-85; discussion 186. [PMID: 23542197 DOI: 10.1097/pep.0b013e31828812d6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To document physical therapist intervention activities and cardiorespiratory response for young children with chronic respiratory insufficiency. METHODS Twelve children born prematurely, 6 to 30 months chronological age and admitted to inpatient pulmonary rehabilitation for oxygen and/or ventilation weaning, were included. During 3 intervention sessions, a second physical therapist recorded intervention activity and heart rate (HR), oxygen saturation (SaO2), and respiratory rate. Total time and median HR, SaO2, and respiratory rate for each activity were calculated. An analysis of variance was used to compare HR and SaO2 across activity based on intersession reliability. RESULTS Sitting activities were most frequent and prone least frequent. Median cardiorespiratory measures were within reference standards for age. No adverse effects were seen during intervention and no significant difference was found in HR and SaO2 among intervention activities. CONCLUSION Young children with chronic respiratory insufficiency are able to tolerate intervention with close monitoring by the physical therapist.
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Dumas HM, Rosen EL, Haley SM, Fragala-Pinkham MA, Ni P, O'Brien JE. Measuring physical function in children with airway support: a pilot study using computer adaptive testing. Dev Neurorehabil 2010; 13:95-102. [PMID: 20222770 DOI: 10.3109/17518420903386179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the responsiveness, examine the scoring range and determine the efficiency of a multidimensional computer adaptive testing version of the Pediatric Evaluation of Disability Inventory (PEDI-MCAT) for children admitted to inpatient pulmonary rehabilitation. METHODS The PEDI-MCAT was completed by clinician report for 30 infants and children. Mean self-care and mobility admission scores were compared with discharge scores for the total group and two diagnostic sub-groups (prematurity and congenital/neurological conditions). The scoring range of the mobility and self-care scales was examined to determine placement of the scores along the overall PEDI-MCAT scale. Efficiency was determined using an internal clock and average number of items required for score generation. RESULTS Mean changes for the total group and both sub-groups were significant for both self-care and mobility, except for the prematurity group's mobility scores. Effect sizes were small-to-moderate. Scores for both groups were at the low end of the scoring ranges. Average time to complete the PEDI-MCAT was 1.57 minutes. Average number of items administered was nine for self-care and 11 for mobility. CONCLUSION The PEDI-MCAT was responsive to change in physical function, although only low-ability items were needed. The PEDI-MCAT can potentially minimize clinician burden in inpatient settings.
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Affiliation(s)
- Helene M Dumas
- Franciscan Hospital for Children, Research Center, Boston, Massachusetts 02135, USA.
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Berry JG, Graham DA, Graham RJ, Zhou J, Putney HL, O’Brien JE, Roberson DW, Goldmann DA. Predictors of clinical outcomes and hospital resource use of children after tracheotomy. Pediatrics 2009; 124:563-72. [PMID: 19596736 PMCID: PMC3614342 DOI: 10.1542/peds.2008-3491] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The objectives are to describe health outcomes and hospital resource use of children after tracheotomy and identify patient characteristics that correlate with outcomes and hospital resource use. PATIENTS AND METHODS A retrospective analysis of 917 children aged 0 to 18 years undergoing tracheotomy from 36 children's hospitals in 2002 with follow-up through 2007. Children were identified from ICD-9-CM tracheotomy procedure codes. Comorbid conditions (neurologic impairment [NI], chronic lung disease, upper airway anomaly, prematurity, and trauma) were identified with ICD-9-CM diagnostic codes. Patient characteristics were compared with in-hospital mortality, decannulation, and hospital resource use by using generalized estimating equations. RESULTS Forty-eight percent of children were <or=6 months old at tracheotomy placement. Chronic lung disease (56%), NI (48%), and upper airway anomaly (47%) were the most common underlying comorbid conditions. During hospitalization for tracheotomy placement, children with an upper airway anomaly experienced less mortality (3.3% vs 11.7%; P < .001) than children without an upper airway anomaly. Five years after tracheotomy, children with NI experienced greater mortality (8.8% vs 3.5%; P <or= .01), less decannulation (5.0% vs 11.0%; P <or= .01), and more total number of days in the hospital (mean [SE]: 39.5 [4.0] vs 25.6 [2.6] days; P <or= .01) than children without NI. These findings remained significant (P < .01) in multivariate analysis after controlling for other significant cofactors. CONCLUSIONS Children with upper airway anomaly experienced less mortality, and children with NI experienced higher mortality rates and greater hospital resource use after tracheotomy. Additional research is needed to explore additional factors that may influence health outcomes in children with tracheotomy.
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Affiliation(s)
- Jay G. Berry
- Complex Care Service, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts,Program for Patient Safety and Quality, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts
| | - Dionne A. Graham
- Program for Patient Safety and Quality, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts,Clinical Research Program, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts
| | - Robert J. Graham
- Critical Care Medicine, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts
| | - Jing Zhou
- Clinical Research Program, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts
| | | | - Jane E. O’Brien
- Complex Care Service, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts,Franciscan Hospital for Children, Boston, Massachusetts
| | - David W. Roberson
- Program for Patient Safety and Quality, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts,Department of Otolaryngology, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts
| | - Don A. Goldmann
- Division of Infectious Diseases and Pediatric Health Services Research, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts
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