Are All Children Equal? An Analysis of the Predictive Value of Selected Pediatric Characteristics of the Referral of Children to Pediatric Home Health Services

ISSUES AND PURPOSE: To examine the predictive value of selected pediatric characteristics of the referral of children to pediatric home health services (PHHS). No empirical studies to date have evaluated the criteria used to determine the need for PHHS or if disparities in the referral of children to PHHS occur. DESIGN AND METHODS: Randomly selected hospital records of 557 children discharged from one pediatric hospital between October 1999 and September 2000 were examined. Sequential logistic regression was used to calculate the odds of being referred to PHHS based on age, race or ethnicity, number of legal guardians in the household, and the number of technological devices at discharge. Insurance was excluded as a predictor because 97% of the study sample was insured. RESULTS: Only the number of technological devices at discharge added predictive value (chi(2)[DF = 3, N= 557]= 42.023, P<0.001) to the SLR model. There was no evidence of disparities in referral. IMPLICATIONS FOR PRACTICE: To ensure availability and equitable access to PHHS, nurses must actively participate in the discharge planning process for all children.     

Health Care Utilization and Costs Associated With Pediatric Chronic Pain

The population prevalence of pediatric chronic pain is not well characterized, in part because of a lack of nationally representative data. Previous research suggests that pediatric chronic pain prolongs inpatient stay and increases costs, but the population-level association between pediatric chronic pain and health care utilization is unclear. We use the 2016 National Survey of Children's Health to describe the prevalence of pediatric chronic pain, and compare health care utilization among children ages 0 to 17 years according to the presence of chronic pain. Using a sample of 43,712 children, we estimate the population prevalence of chronic pain to be 6%. In multivariable analysis, chronic pain was not associated with increased odds of primary care or mental health care use, but was associated with greater odds of using other specialty care (odds ratio [OR]?=?2.01, 95% confidence interval [CI] = 1.62–2.47; P?<?.001), complementary and alternative medicine (OR?=?2.32, 95% CI = 1.79–3.03; P?<?.001), and emergency care (OR?=?1.62, 95% CI = 1.29–2.02; P?<?.001). In this population-based survey, children with chronic pain were more likely to use specialty care but not mental health care. The higher likelihood of emergency care use in this group raises the question of whether better management of pediatric chronic pain could reduce emergency department use.

Nursing and Home Care in Europe

The demographic trend of a rapidly ageing society becomes increasingly persuasive. More chronically ill patients will be discharged to home care. More people with psychotic problems and debilitating diseases will be living in communities. All require nursing care. This situation is recognized everywhere and no boundaries can change this future.     

Access to Health Care

Purpose: To describe and analyze conceptual and operational definitions of health care access for future nursing theory, practice, and policy. Access to health care is a major health policy concern. However, the elements of access to care are not well understood. As a result, how access is addressed is often inconsistent and unclear.
Organizing construct: Walker and Avant's framework for concept analysis.
Sources: Published literature in nursing and health services from the 1960s to the 1990s. The analysis was done in 1997 for this integrative review of nursing and nonnursing literature.
Methods: Integrative literature review in 1997.
Findings: Access is a complex idea defined in many ways. One of the most comprehensive definitions of access is by the World Health Organization (WHO). Multidementional barriers and facilitators to access vary by community and country.
Conclusions: Societies may define access differently at different stages of development. Scales to measure some dimensions of access are available; however, newer and better measures are needed and are being developed and tested. Data on each of the dimensions are needed for comprehensive assessment of access to health care in all countries at all stages of development.     

Child Care Health Consultation: An Ecological Model

ISSUES AND PURPOSE. To present an ecological model of child care health consultation that defines the role of the health consultant as a resource and advocate within child care programs, as well as a supportive link among families, child care providers, and the healthcare system.
CONCLUSIONS. Nurses have provided health consultation to child care programs for more than 30 years and represent the majority of health consultants nationally. Pediatric nurses and advanced practice nurses are well prepared to shape and lead the development of this emerging role.
PRACTICE IMPLICATIONS. With expertise in caring for children, understanding families, and care across systems, pediatric nurses and advanced practice nurses should engage in current state and national efforts to develop child care health consultatits.     

小儿外科健康教育初探

健康教育是整体护理的重要组成部分,小儿健康教育有着自己的特点。本文通过实例介绍了对住院病儿及家长的不同教育方式及收到的临床效果,总结了健康教育对护士专业的要求及收获。     

Population Health and Tailored Medical Care in the Home: the Roles of Home-Based Primary Care and Home-Based Palliative Care

With the growth of value-based care, payers and health systems have begun to appreciate the need to provide enhanced services to homebound adults. Recent studies have shown that home-based medical services for this high-cost, high-need population reduce costs and improve outcomes. Home-based medical care services have two flavors that are related to historical context and specialty background—home-based primary care (HBPC) and home-based palliative care (HBPalC). Although the type of services provided by HBPC and HBPalC (together termed “home-based medical care”) overlap, HBPC tends to encompass longitudinal and preventive care, while HBPalC often provides services for shorter durations focused more on distress management and goals of care clarification. Given workforce constraints and growing demand, both HBPC and HBPalC will benefit from working together within a population health framework—where HBPC provides care to all patients who have trouble accessing traditional office practices and where HBPalC offers adjunctive care to patients with high symptom burden and those who need assistance with goals clarification. Policy changes that support provision of medical care in the home, population health strategies that tailor home-based medical care to the specific needs of the patients and their caregivers, and educational initiatives to assure basic palliative care competence for all home-based medical providers will improve access and reduce illness burden to this important and underrecognized population.     

Using Home Modifications to Promote Self-Maintenance and Mutual Care

Old-age homes, while not a recent phenomenon in India, are growing in number, especially in the southern part of the country. A study of nearly 50 such homes had, as one focus, the extent to which these facilities have modified the physical environment to enable residents to age in place. Not all desirable home modifications (HMs) are widely available; for example, only 25% had special seating in bathing areas, 48% used ramps and 21% employed handrails in hallways and bathing areas. In addition, many HMs are inelegant or primitive by U.S. and European standards, but still provide needed environmental support for residents. These HMs are important to enhance self-maintenance and also to enable residents to help each other. Mutual care helps build and maintain a sense of community, in keeping with Indian traditions of village-level concern for common well-being, and substitutes for small numbers of staff. With huge numbers of Indian elders (c. 170 million) in the next century, greater use of HMs in group homes will be vital to ensure a high quality of life.     

Improving Access to Care for Pediatric Patients With Hypertension

Elevated blood pressure, Stage 1 hypertension, and Stage 2 hypertension in childhood and adolescence correlate with hypertension in adulthood. Ambulatory blood pressure monitors are a valuable tool for diagnosing hypertension. This project developed an advanced practice registered nurse (APRN)-managed specialty pediatric hypertension clinic to increase access to blood pressure monitor device screening and thus improve care. The number of monitors increased from 7 to 28, and the turnaround time from send out/placement to receipt of the monitor decreased from an average of 22 to 5 days. APRN-managed specialty clinics are a proven method to improve pediatric patient care.     

Reconceptualizing Compliance in Home Health Care

The term "compliance" and its traditional definitions frequently are criticized in the literature. Although a number of authors advocate a collaborative model of compliance, with compliance decisions and responsibilities for health outcomes shared by provider and patient, few describe this model in practice. This study investigated compliance communication in two home care agencies. Findings from interviews with 6 nurses and observation during home visits to 25 patients (N = 31) revealed a prosocial, collaborative model of compliance that coincides with the participative model of medical care (Smith, 1989) and a redefinition of compliance advanced by Kontz (1989).     

Disparities in Health Care: An Overview

The most important predictor of quality of health care across all racial and ethnic groups is access, especially insurance status and the ability to pay for health care. If we consider populations with equal access to health care, two groups emerge with differing qualities of health care: non-minority and minority populations. When studies control for the stage of disease at presentation, comorbidities, severity of illness, and other variables, substantial differences in health care based on race and ethnicity can still be found. Raising the consciousness of this issue is an important step toward recognizing and eliminating health care disparities.     

Measuring Patient-Level Clinical Outcomes of Home Health Care

PURPOSE: To examine the use of the Outcomes Assessment and Information Set (OASIS) data to analyze patient-level outcomes of home health care. DESIGN: OASIS data were obtained on 1,015 patients who received home health care services for 60 days or fewer from a large, independent home health agency between August 1998 and December 1999. METHODS: An index was constructed consisting of 16 OASIS measures, primarily activities of daily living (ADL) and instrumental activities of daily living (IADL). Scores were computed for functional status on admission and at discharge. Predictors of functional status at discharge were identified by regression analysis. FINDINGS: 78.1% of patients improved, 18.5% declined, and 2.8% showed no change. The model explained 57.2% of variance in functional status at discharge. Age, visual impairment, having Medicaid as a payer, urinary incontinence, cognitive impairment, and use of unplanned or emergency care were negatively associated with functional outcomes of care. Being treated for open wounds or lesions, cardiovascular and orthopedic conditions were positively associated with functional outcomes. CONCLUSIONS: OASIS data can be used to analyze patient-level functional outcomes of short-term home health services. Further research is needed to continue refining methods of analyzing patient outcomes and their predictors.     

Hospital Readmission From Home Health Care Before and After Prospective Payment

PURPOSE: To describe and compare clients who were readmitted to the hospital during an episode of home health care, before and after the inception of the prospective payment system (PPS). DESIGN: A longitudinal mixed design was used to replicate a study conducted 9 years previously (pre-PPS) in the same home care agency in the central part of the United States. METHODS: Seventy-six closed-case medical records from a not-for-profit hospital-affiliated home care agency were retrospectively reviewed and compared to pre-PPS data. The same data collection tool, the Hospital Readmission Inventory, was used for both pre- and post-PPS studies. Nurse administrators at the data collection agency were interviewed concerning comparative results. FINDINGS: Currently readmitted clients were sicker than were those in the previous research report, they were readmitted sooner for a different diagnosis, and they had less continuity of services. CONCLUSIONS: The home health care industry has undergone a dramatic change in payment for services, from fee-for-service to PPS. Of particular concern is the adverse patient outcome of an unplanned hospital readmission. Prior studies have characterized such patients in home health care, but no comparative reports were found in a literature search since the inception of PPS. Findings from this study indicated that an increased emphasis on cost containment and higher-risk clients appear to have changed patterns of care delivery.     

目标性镇静护理在儿科监护室中的应用

目的探讨目标性镇静护理在儿科监护室中的应用效果。方法便利抽样法选取2015年3-4月入住上海交通大学附属儿童医院儿科监护室的患儿35例,设为观察组,采用目标性镇静护理;同法选取2015年1-2月目标镇静法实施前同一儿科监护室患儿35例设为对照组,采用常规镇静护理。分析比较两组患儿镇静效果、镇静前后和苏醒后生命体征变化以及遵医依从性情况。结果观察组患儿镇静效果明显高于对照组,两组相比较差异有统计学意义(P0.05);观察组患儿入住监护室镇静护理过程中生命体征变化平稳,与对照组相比,差异无统计学意义(P0.05);观察组患儿在转出监护室时遵医依从性优于对照组,两组比较,差异有统计学意义(P0.05)。结论目标性镇静护理在儿科监护室中应用明显提高了患儿遵医依从性,确保医疗活动的有效性,值得临床推荐应用。