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Outcome of home care for technology‐dependent children: Success of an independent, community‐based case management model
Author(s) -
Fields Alan I.,
Coble Deborah Hardy,
Pollack Murray M.,
Kaufman Joanne
Publication year - 1991
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.1950110407
Subject(s) - medicine , mechanical ventilation , respiratory failure , disease management , respiratory care , intensive care medicine , pediatrics , disease , emergency medicine , parkinson's disease
Case management is important for successful home care of technology‐dependent, respiratory‐disabled children. Traditionally, the medical model of hospital‐based home care and case management has been used for these children. The outcome may be different from when using independent, community‐based home care and case management. We evaluated the results of 28 technology‐dependent children [23 receiving mechanical ventilation and 5 receiving continuous positive airway pressure (CPAP)] from 8 hospitals, who utilized an independent, communtiy‐based, case management group to coordinate home care. After 26.3 ± 20.6 months of follow‐up, 13 children (46%) remained technology‐dependent, 10 (36%) were technology‐independent, and 5 (18%), all with neurologic dysfunction, had died. Only one death was caused by a complication of technology. All children with congenital anomalies ( n = 4), primary pulmonary disease ( n = 8), and neuromuscular disease ( n = 4) survived, and 9 (56%) were weaned from technological support. Children with chronic respiratory failure secondary to central neurologic dysfunction (n = 12) did poorly: 5 died, 6 remained technology‐dependent, and only 1 became independent of technology. Children with neuromuscular diseases tended to use less home care nursing at a lower home care cost. Parent satisfaction was high among those who responded (82%), indicating that the child, siblings, and family were better off with the child at home. These outcomes suggest that community‐based home care and case management is a reasonable alternative to the hospital‐based model.