title: Outcome of home care for technology-dependent children: success of an independent, community-based case management model.
abstract: 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, community-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.
authors.affiliation: Coordinating Center for Home and Community Care, Inc., Millersville, Maryland.
authors.forename: A I
authors.initials: AI
authors.lastname: Fields
authors.forename: D H
authors.initials: DH
authors.lastname: Coble
authors.forename: M M
authors.initials: MM
authors.lastname: Pollack
authors.forename: J
authors.initials: J
authors.lastname: Kaufman
mesh_terms: D000015:Abnormalities, Multiple / Q000451:nursing; D001997:Bronchopulmonary Dysplasia / Q000451:nursing; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009468:Neuromuscular Diseases / Q000451:nursing; D010347:Patient Care Planning; D011175:Positive-Pressure Respiration / Q000451:nursing*; D012121:Respiration, Artificial / Q000451:nursing*; D016896:Treatment Outcome