Does the Implementation of Children's Hospital in the Home affect Health
Outcomes for Children with Chronic Respiratory Conditions? A
non-contemporary retrospective cohort comparison study
Abstract
Objective To investigate whether the implementation of a Children’s
Hospital in the Home (CHITH) service affects clinical and service
outcomes for children with chronic respiratory conditions including
cystic fibrosis and non-CF bronchiectasis. Study Design A
non-contemporary retrospective cohort comparison study. Setting/Patients
Children aged between 1 and 17.99 years who were admitted to Gold Coast
University Hospital (GCUH) with a chronic respiratory condition for
pulmonary optimisation were eligible. Methods A clinical audit was
utilised to compare children with chronic respiratory conditions who
were admitted to GCUH in (a) the 12 months prior to implementation of
CHITH and (b) the 12-month period following the implementation of CHITH.
Outcomes of interest included lung function; inpatient length of stay
(days); duration on intravenous antibiotics and weight gain. Normally
distributed data was compared using the t-test, while non-parametric
data was analysed with the Mann-Whitney test. Results Data was analysed
from 58 admissions, 27 (46.55%) of which occurred in the 12 months of
traditional management and 31 (53.45%) in the 12 months following the
implementation of the CHITH service. A statistically significant
reduction in inpatient length of stay was noted following implementation
of the CHITH service: 14.25 versus 6.0 days (p-value=0.0001). The
pre-CHITH cohort had a non-significant mean improvement of 7.625% in
their FEV1 (pred%) compared to 9.75% in the CHITH cohort
(p-value=0.44). There was no significant difference in the secondary
clinical outcomes. Conclusion The CHITH service provided equitable
clinical outcomes for children with a chronic respiratory condition
whilst significantly reducing inpatient length of stay.