Project Description:
This is a research project using a mixed-methods approach to determine the predictors of increased days at home versus days hospitalized for children with invasive home mechanical ventilator (HMV) assistance throughout the US. These patients, with complex genetic, pulmonary, cardiac, and neuromuscular disorders, have prolonged hospital stays for non-medical reasons and contribute to high percentages of overall pediatric healthcare expenditures. The project contains three aims and three separate but cohesive studies. The first aim is to understand parental and home nursing perspectives on which circumstances, resources, and child characteristics lead to expeditious discharge and fewer readmissions. This will be achieved through completing interviews with home care nurses and parents of children with home mechanical ventilation. The second aim will utilize national Medicaid claims to determine which patient, family, and community healthcare factors, particularly home nursing availability, predict positive outcomes including a shorter index hospital stay after tracheostomy placement, a lower likelihood of readmissions and increased days at home. The third and final aim is to understand functional levels within motoric, cognitive, and communicative domains of children with home mechanical ventilation living in the community. This project also contains an educational component which provides advanced training in qualitative, Medicaid claims, and cost-effectiveness analysis. The research project is focused on determining strategies to support children with HMV: the most medically fragile, neurodevelopmentally vulnerable, and highest resource-consuming pediatric patients.
