title: Pediatric Hospital Discharges to Home Health and Postacute Facility Care: A National Study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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
  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.
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts2Franciscan Hospital for Children, Boston, Massachusetts.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
authors.affiliation: Children's Hospital Association, Overland Park, Kansas.
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: Franciscan Hospital for Children, Boston, Massachusetts.
authors.forename: Helene
authors.initials: H
authors.lastname: Dumas
authors.affiliation: St Mary's Healthcare System for Children, Bayside, New York.
authors.forename: Edwin
authors.initials: E
authors.lastname: Simpser
authors.affiliation: Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland, Ohio.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Whitford
authors.affiliation: Children's Hospital Colorado, University of Colorado, Aurora.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Wilson
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Margaret
authors.initials: M
authors.lastname: O'Neill
authors.affiliation: University of Texas Southwestern Medical Center and Children's Medical Center Dallas.
authors.forename: Vineeta
authors.initials: V
authors.lastname: Mittal
authors.affiliation: Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Rishi
authors.initials: R
authors.lastname: Agrawal
authors.affiliation: Children's Specialized Hospital, New Brunswick, New Jersey.
authors.forename: Michael
authors.initials: M
authors.lastname: Dribbon
authors.affiliation: Children's Specialized Hospital, New Brunswick, New Jersey.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Haines
authors.affiliation: Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland, Ohio.
authors.forename: Christine
authors.initials: C
authors.lastname: Traul
authors.affiliation: Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland, Ohio.
authors.forename: Michelle
authors.initials: M
authors.lastname: Marks
authors.affiliation: Franciscan Hospital for Children, Boston, Massachusetts.
authors.forename: Jane
authors.initials: J
authors.lastname: O'Brien
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid; D006278:Medicare; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019467:Subacute Care / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult