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      Analyses of the effectiveness of a Brazilian pediatric home care service: a preliminary study

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          Abstract

          Background

          Technological advances in health care currently provide better care conditions and have increased survival rates of premature infants, along with increasing the life expectancy of chronically ill children. In this context, the home care service has emerged as an effective tool for the treatment of this group of children. Thus, this preliminary study aimed at evaluating the effectiveness of the Home Care Service (HCS) with regard to pediatric care.

          Methods

          A cross-sectional study was performed through a medical record analysis of a tertiary hospital in Minas Gerais/Brazil. Two groups were compared: 36 patients from the HCS (home group) and 13 patients hospitalized with an indication for home care (hospital group). To analyze the effectiveness of HCS, we evaluated the number of readmissions, infection rate, number of procedures, and optimization of beds.

          Results

          The hospital group presented 6.04 times more infections and was submitted to 6.43 times more procedures. The home group presented lower readmission rates; with 41.66% of children studied not being readmitted and 76.19% of those who needed readmissions did so after more than 30 days from hospital discharge. HCS optimized hospital beds and allowed, over five (5) years, the hospitalization of around 102 patients in the hospital studied.

          Conclusion

          In this preliminary study, HCS reduced the number of procedures and infections compared to hospitalized patients. Moreover, HCS presented lower readmission rates and optimized hospital beds, which could be considered an indication of effectiveness.

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          Home care in Europe: a systematic literature review

          Nadine Genet, Wienke Boerma, Dionne S. Kringos … (2011)
          Background Health and social services provided at home are becoming increasingly important. Hence, there is a need for information on home care in Europe. The objective of this literature review was to respond to this need by systematically describing what has been reported on home care in Europe in the scientific literature over the past decade. Methods A systematic literature search was performed for papers on home care published in English, using the following data bases: Cinahl, the Cochrane Library, Embase, Medline, PsycINFO, Sociological Abstracts, Social Services Abstracts, and Social Care Online. Studies were only included if they complied with the definition of home care, were published between January 1998 and October 2009, and dealt with at least one of the 31 specified countries. Clinical interventions, instrument developments, local projects and reviews were excluded. The data extracted included: the characteristics of the study and aspects of home care 'policy & regulation', 'financing', 'organisation & service delivery', and 'clients & informal carers'. Results Seventy-four out of 5,133 potentially relevant studies met the inclusion criteria, providing information on 18 countries. Many focused on the characteristics of home care recipients and on the organisation of home care. Geographical inequalities, market forces, quality and integration of services were also among the issues frequently discussed. Conclusions Home care systems appeared to differ both between and within countries. The papers included, however, provided only a limited picture of home care. Many studies only focused on one aspect of the home care system and international comparative studies were rare. Furthermore, little information emerged on home care financing and on home care in general in Eastern Europe. This review clearly shows the need for more scientific publications on home care, especially studies comparing countries. A comprehensive and more complete insight into the state of home care in Europe requires the gathering of information using a uniform framework and methodology.
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            Is the Readmission Rate a Valid Quality Indicator? A Review of the Evidence

            Claudia Fischer, Hester F Lingsma, Perla Marang-van de Mheen … (2014)
            Introduction Hospital readmission rates are increasingly used for both quality improvement and cost control. However, the validity of readmission rates as a measure of quality of hospital care is not evident. We aimed to give an overview of the different methodological aspects in the definition and measurement of readmission rates that need to be considered when interpreting readmission rates as a reflection of quality of care. Methods We conducted a systematic literature review, using the bibliographic databases Embase, Medline OvidSP, Web-of-Science, Cochrane central and PubMed for the period of January 2001 to May 2013. Results The search resulted in 102 included papers. We found that definition of the context in which readmissions are used as a quality indicator is crucial. This context includes the patient group and the specific aspects of care of which the quality is aimed to be assessed. Methodological flaws like unreliable data and insufficient case-mix correction may confound the comparison of readmission rates between hospitals. Another problem occurs when the basic distinction between planned and unplanned readmissions cannot be made. Finally, the multi-faceted nature of quality of care and the correlation between readmissions and other outcomes limit the indicator's validity. Conclusions Although readmission rates are a promising quality indicator, several methodological concerns identified in this study need to be addressed, especially when the indicator is intended for accountability or pay for performance. We recommend investing resources in accurate data registration, improved indicator description, and bundling outcome measures to provide a more complete picture of hospital care.
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              Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care.

              Bryan D. Moyer, Linda Humphrey, R Leblond … (2012)
              Unsustainable rising health care costs in the United States have made reducing costs while maintaining high-quality health care a national priority. The overuse of some screening and diagnostic tests is an important component of unnecessary health care costs. More judicious use of such tests will improve quality and reflect responsible awareness of costs. Efforts to control expenditures should focus not only on benefits, harms, and costs but on the value of diagnostic tests-meaning an assessment of whether a test provides health benefits that are worth its costs or harms. To begin to identify ways that practicing clinicians can contribute to the delivery of high-value, cost-conscious health care, the American College of Physicians convened a workgroup of physicians to identify, using a consensus-based process, common clinical situations in which screening and diagnostic tests are used in ways that do not reflect high-value care. The intent of this exercise is to promote thoughtful discussions about these tests and other health care interventions to promote high-value, cost-conscious care.
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                Author and article information

                Contributors
                Antônio José Lana de Carvalho: antoniolanac@gmail.com
                Hyster Martins Ferreira: hyster.martins@gmail.com
                Eliza Fernanda Borges: eliza.borges@hotmail.com
                Laerte Honorato Borges Junior: laerteh@yahoo.com.br
                Ana Laura Teodoro de Paula: altdp1234@gmail.com
                Wallisen Tadashi Hattori: wallhattori@gmail.com
                e Vivian Mara Gonçalves de Oliveira Azevedo:
                ORCID: http://orcid.org/0000-0002-7514-1508
                viviangazevedo1@gmail.com
                Journal
                Journal ID (nlm-ta): BMC Health Serv Res
                Journal ID (iso-abbrev): BMC Health Serv Res
                Title: BMC Health Services Research
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6963
                Publication date (Electronic): 22 May 2019
                Publication date PMC-release: 22 May 2019
                Publication date Collection: 2019
                Volume: 19
                Electronic Location Identifier: 324
                Affiliations
                [1 ]ISNI 0000 0004 4647 6936, GRID grid.411284.a, Graduate Program in Health Science, Faculty of Medicine, , Federal University of Uberlândia, ; 1720 - Pará Ave., Umuarama, Uberlândia, 38405-320 Brazil
                [2 ]ISNI 0000 0004 4647 6936, GRID grid.411284.a, Home Care Service, Hospital of Clinics of Uberlândia, , Federal University of Uberlândia, ; 1720 - Pará Ave, Umuarama, Uberlândia, 38405-320 Brazil
                [3 ]ISNI 0000 0004 4647 6936, GRID grid.411284.a, Institutional Program for Voluntary Scientific Initiation, Medical School, , Federal University of Uberlândia, ; 1720 - Pará Ave., Bloco 2U, Umuarama, Uberlândia, 38402-022 Brazil
                [4 ]ISNI 0000 0004 4647 6936, GRID grid.411284.a, Department of Public Health, Faculty of Medicine, , Federal University of Uberlândia, ; 1720 - Pará Ave., Umuarama, Uberlândia, 38405-320 Brazil
                [5 ]ISNI 0000 0004 4647 6936, GRID grid.411284.a, Faculty of Physical Education and Physical Therapy, , Federal University of Uberlândia, ; 1286 - Benjamin Constant St., Nossa Sra. Aparecida, Uberlândia, 38400-678 Brazil
                Author information
                http://orcid.org/0000-0002-7514-1508
                Article
                Publisher ID: 4148
                DOI: 10.1186/s12913-019-4148-4
                PMC ID: 6532231
                PubMed ID: 31117997
                SO-VID: bd374743-73c7-4351-a76d-60bf92d11e34
                Copyright © © The Author(s). 2019
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 7 January 2019
                Date accepted : 8 May 2019
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Health & Social care
                Keywords: home care,health service effectiveness,chronic disease
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: home care, health service effectiveness, chronic disease

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