A systematic review of the costs and effectiveness of different models of paediatric home care

Parker G, Bhakta P, Lovett C A, Paisley S, Olsen R, Turner D, Young B
Record ID 32003000027
Authors' objectives:

The aims of this study were to establish: - the range and types of paediatric home care (PHC) - the effectiveness and costs of PHC - if and how cost-effectiveness differs between different groups of children - the speed of growth of the evidence base - what recommendations could be made for further research.

Authors' results and conclusions: Very low birth weight babies: There was limited reporting of the clinical or developmental outcomes of earlier discharge, accompanied by home care, for very low birth weight babies. Physical and mental development may be enhanced but sample sizes were too small to be confident about this. PHC may be cheaper than the alternative but the costing methods used were weak. Impact on family members was rarely reported. Diabetes and asthma: Whether PHC for children with diabetes or asthma affects clinical or social outcomes or costs, for children, their families or the health service remained unsure. It was concluded that early discharge with home care after diagnosis may reduce parents' costs, largely by reducing children's initial length of hospital stay. Technology-dependent children: Studies of home intravenous therapy, parenteral and enteral nutrition, oxygen therapy, dialysis and nebuliser therapy were identified. Controlled studies were rare, as were studies that measured clinical outcomes, impact on families or childrens quality of life. PHC for technology-dependent children may be cheaper for the health service, but little else could be concluded about it. Children with mental health problems: Apart from parents satisfaction with services, few other effects were reported. It was concluded that health service use after home care may be lower, with reductions in health service costs. Admission to residential care may also be lower, with reductions in social care costs. Generic paediatric home care: Only one study was identified. No major clinical effects were evident at early follow-up. Very partial follow-up after 5 years suggested that psychological adjustment may be improved by PHC. Family satisfaction with services was higher with home care, although no direct impact on the childrens mothers or on the family was detected. No costings have been reported.
Authors' recommendations: The evidence base in this area was weak, as were methods. Common methodological weaknesses included sample sizes, timing of data collection, objectivity, long-term follow-up, accurate description of PHC models, impact beyond the hospital, and the ages of children researched. Narrow ranges of children and parents - in terms of socio-economic status, ethnicity and geographical location - were included in studies, and children's views were largely absent. With the current state of evidence, it was concluded that no confident messages could be given to the health service about PHC.
Authors' methods: Systematic review
Project Status: Completed
URL for project: http://www.hta.ac.uk/1132
Year Published: 2002
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Child
  • Costs and Cost Analysis
  • Diabetes Mellitus
  • Home Care Services
  • Infant, Low Birth Weight
  • Mental Disorders
  • Pediatrics
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name: journals.library@nihr.ac.uk
Contact Email: journals.library@nihr.ac.uk
Copyright: 2009 Queen's Printer and Controller of HMSO
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