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Pediatric home hospitalization improves the quality of life of children and their families, involving them in their children’s care, while favoring the work-life balance of the family. In this context, technology guarantees accessibility to assistance, which provides security to users. From the perspective of the health care system, this could lower the demand for hospital services and reduce hospitalization costs.
This study aimed to assess families’ degree of satisfaction and acceptability of pediatric telehomecare and explore the clinical characteristics of children benefiting from the program.
A total of 95 children and their families participated in the home-hospitalization pilot program operated by Sant Joan de Déu Hospital in Barcelona, Spain. Families were visited once a day and patients were monitored using a kit consisting of a scale, a thermometer, a pulse oximeter, and a blood pressure monitor. Data on parental experience, satisfaction, safety, and preference for care was collected by means of a questionnaire. Data about the children’s characteristics were collected from medical records. Descriptive and comparative statistics were used to analyze the data.
A total of 65 survey respondents expressed very high levels of satisfaction. Families reported their experiences as being very positive, preferring home hospitalization in 94% (61/65) of cases, and gave high scores regarding the use of telemonitoring devices. The program did not record any readmissions after 72 hours and reported a very low number of adverse incidents. The user profile was very heterogeneous, highlighting a large number of respiratory patients and patients with infections that required endovenous antibiotic therapy.
Pediatric home hospitalization through telemonitoring is a feasible and desirable alternative to traditional hospitalization, both from the perspective of families and the hospital. The results of this analysis showed a very high degree of satisfaction with the care received and that the home-based telemonitoring system resulted in few adverse incidents.
Pediatric home-based care is a good alternative to conventional hospitalization insofar as it is consistent with a care model that places a high value on a more humanized form of health care and encourages self-care and children’s rights. The provision of this type of care for children with acute and chronic illnesses is increasing in western countries due to technological developments [
The technology available today allows for remote and real-time monitoring of a patient’s clinical status and regular follow-up with families. Developments in health care equipment means that many diagnostic and treatment procedures normally conducted in a clinical environment can be provided at home [
Home is a child’s natural environment. The European Association for Children in Hospital Charter establishes that a child should only be admitted to hospital if it is absolutely necessary and must be discharged as soon as possible [
In this context, the Sant Joan de Déu Hospital in Barcelona decided to initiate a pilot program on pediatric home-based hospitalization care. This study aims to (1) measure the impact of the intervention on the satisfaction of patients and their families and (2) determine the clinical and sociodemographic characteristics of the children benefiting from the program in view of the possible deployment of the intervention.
The Sant Joan de Déu Hospital in Barcelona is a third-level university hospital located in Catalonia, Spain, which specializes in the fields of pediatrics, gynecology, and obstetrics. It is a privately owned hospital that operates as part of the public health system and the Catalan hospital network. It sees approximately 27,000 cases annually, with around 250,000 outpatient consultations; 15,000 surgical interventions; and 160,000 emergencies. The study involving the pediatric home-based care pilot program took place between April 1 and June 30, 2019. The candidate users were selected in accordance with the criteria outlined in
Distance: patient’s home is no more than 30 minutes from the hospital
Clinical stability: patient is stable without forecasting decompensations in the short term
Voluntary consent is given by the family and, where applicable, by the child
Habitability conditions of the home: composition of the family group, individual room for the patient, cleanliness condition of the home, availability of the minimum infrastructure for the patient’s personal hygiene, and the ability to comply with the prescribed diet, environmental conditions of noise, and ambient temperature
Prior family training to ensure continuity in the care process
Possibility of establishing permanent telephone communication
When the medical team detected a potential case, they contacted the home-hospitalization team, who assessed it and made sure it met the selection criteria. In that case, the family was informed of what home hospitalization involves and was provided with information in writing. If the family agreed, they were asked to give informed consent. Finally, the team’s nurse trained the family and empowered them to carry out the necessary care; when leaving, they were issued a kit (see
Contents of the remote telemonitoring kit.
Device | Brand (manufacturer) | Model | Medical device certification |
Blood pressure monitor | iHealth View (iHealth Labs) | BP75 | Yes |
Pulse oximeter | iHealth Air (iHealth Labs) | P03M | Yes |
Scale | iHealth Lina (iHealth Labs) | HS2 | No |
Thermometer | OMRON (Omron Healthcare) | GentleTemp 521 | Yes |
Tablet | iPad (Apple) | MR6P2TY/A | No |
The intervention considered two types of complementary health care: face-to-face, with a daily visit, and telecare (ie, 24/7 continuous care via remote real-time monitoring, phone calls, and videoconferencing). The human resources devoted to the project were 1 pediatrician, 2.7 nurses, technical support, and part-time administrative staff. Clinicians traveled from the hospital by means of a car and there were 10 remote telemonitoring kits.
Once the intervention was finished, an ad hoc, nonvalidated, and self-administered survey was conducted using Google’s online survey tool (see
This was a unicentric, single-arm, interventional prospective study with no control group. The statistical program R, version 3.6.1 (The R Foundation), was used for the statistical analyses.
The study was approved by Sant Joan de Déu Hospital’s Ethical Committee for Clinical Research (registration No. 88-19) and was carried out in accordance with the Helsinki Declaration [
Participant characteristics are shown in
The cohort studies did not show any security incidents related to medication administration. However, there were 4 readmitted patients out of 95 (4%). In 2 cases, readmission was due to the evolution of the disease (ie, a nephrotic syndrome that developed into a bronchospasm and a peritonsillar phlegmon due to poor control of pain). After these 2 readmissions, some adjustments were made to minimize problems that could have been prevented; this included a deeper interview with families, explaining how the program works and what the terms and conditions are. Also, patients who required oxygen were not discharged from hospital until the oxygen supply was at home.
In 1 case, a bronchospasm occurred because a supply of oxygen was not provided during the home hospitalization. In this case, the bronchospasm occurred due to a nephrotic syndrome caused by the lack of compliance with the medical indications at home. The patients who were hospitalized with the peritonsillar phlegmon due to poor control of pain, and the bronchospasm due to lack of oxygen, returned home the next day. These readmissions should be interpreted as a sign of program success, because each family freely decided to resume home hospitalization. In the cases of poor control of pain and the lack of oxygen supply, once controlled, the family felt secure to go home.
Survey results regarding general satisfaction with the intervention are reported in
Most of the respondents (49/64, 77%) received their first home visit less than 24 hours following their home hospitalization and did not have to call to ask for help (35/65, 54%); for those who did ask for help, the problem was resolved quickly (30/33, 91%). They valued the fact that the pediatrician and the nurses worked in a coordinated way and that their home visit lasted a sufficient amount of time (65/65, 100%).
Sociodemographic characteristics of the sample.
Characteristic | Values (N=95) | ||
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Total | 95 (100) | |
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Boy | 53 (56) | |
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Girl | 42 (44) | |
Age (years), mean (SD) | 4.22 (4.57) | ||
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Total | 95 (100) | |
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Hospitalization | 85 (89) | |
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Outpatient visits | 8 (8) | |
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Emergencies | 2 (2) | |
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Total | 95 (100) | |
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Pediatrics | 80 (84) | |
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Nephrology | 6 (6) | |
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Surgery | 5 (5) | |
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Orthopedic surgery and traumatology | 2 (2) | |
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Gastroenterology | 1 (1) | |
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Others | 1 (1) | |
Distance (km) to hospital, mean (range) | 11.72 (10-50) | ||
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Total | 95 (100) | |
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Mother | 54 (57) | |
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Mother and father | 35 (37) | |
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Father | 5 (5) | |
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Other | 1 (1) | |
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Total | 48 (100) | |
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Peripheral route | 44 (92) | |
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Peripherally inserted central catheter | 2 (4) | |
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Broviac | 1 (2) | |
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Midline | 1 (2) | |
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Total | 89 (100) | |
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Every 24 hours | 36 (40) | |
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Every 8 hours | 22 (25) | |
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Every 4 hours | 21 (24) | |
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Every 6 hours | 7 (8) | |
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Every 12 hours | 2 (2) | |
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Continuous | 1 (1) |
Survey results regarding general satisfaction with the intervention.
Survey question and responses | Participants (N=65), n (%) | |
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Total | 64 (100) |
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Between 1 and 3 days | 15 (23) |
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Less than 1 day | 49 (77) |
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Total | 65 (100) |
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Yes | 30 (46) |
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No | 35 (54) |
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||
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Total | 33 (100) |
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Yes | 30 (91) |
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No | 3 (9) |
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||
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Total | 65 (100) |
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Yes | 65 (100) |
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No | 0 (0) |
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||
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Total | 65 (100) |
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Yes | 65 (100) |
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No | 0 (0) |
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||
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Total | 65 (100) |
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Excellent | 60 (92) |
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Very good | 5 (8) |
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Total | 65 (100) |
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Excellent | 54 (83) |
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Very good | 11 (17) |
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Total | 65 (100) |
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As expected | 49 (75) |
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Less than expected | 14 (22) |
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More than expected | 2 (3) |
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Total | 65 (100) |
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Yes | 2 (3) |
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No | 61 (94) |
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I don’t know | 2 (3) |
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Total | 63 (100) |
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Yes | 63 (100) |
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No | 0 (0) |
Survey results regarding satisfaction with the devices are reported in
Survey results regarding satisfaction with the devices.
Survey question and responses | Values (N=65) | |
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Total | 58 (100) |
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Easy | 47 (81) |
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Neither easy nor difficult | 3 (5) |
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I did not access the program | 8 (14) |
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Total | 54 (100) |
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Yes | 49 (91) |
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No | 5 (9) |
How would you rate the communication with the clinical team using this tool? (n=59), mean scorea (SD) | 4.61 (0.65) | |
How would you rate the utility of the videoconferencing sessions? (n=57), mean score (SD) | 4.28 (1.02) | |
Of the devices you were issued, together with the tablet, how would you rate the scale? (n=38), mean score (SD) | 4.25 (1.02) | |
Of the devices you were issued, together with the tablet, how would you rate the thermometer? (n=48), mean score (SD) | 3.79 (1.36) | |
Of the devices you were issued, together with the tablet, how would you rate the pulse oximeter? (n=45), mean score (SD) | 4.21 (1.12) | |
Of the devices you were issued, together with the tablet, how would you rate the blood pressure monitor? (n=45), mean score (SD) | 4.19 (1.17) |
aScores were measured on a scale from 0 (
The results of this analysis showed a high degree of satisfaction with the care received and highlight the fact that the telehomecare system did not generate significant adverse incidents. Overall, the intervention (ie, training, face-to-face visits, and telemonitoring) enabled the families to be self-sufficient regarding their children’s care. Their satisfaction with the devices was very good and their perception of accessibility was regarded as excellent.
This study assessed the impact of the pediatric, home-hospitalization, pilot program of the Sant Joan de Déu Hospital in Barcelona on the satisfaction of patients and their families; the study also assessed the clinical and sociodemographic characteristics of the children benefiting from the program in view of the potential deployment of the intervention. Although a small sample has been studied, the experience suggests that the intervention could be extended to patients originating from specialties other than the pediatric specialty (ie, surgery, orthopedic surgery and traumatology, gastroenterology, and nephrology).
During the pilot study, a problem with the size of the devices was identified, as they are not always suited to the physiology of pediatric patients, meaning the families used them less. This factor should be taken into account in view of the possible extension of the intervention in the hospital itself or in any replication of the experience.
Finally, the guarantee of the anonymity of the information gathered by the survey has made it impossible to cross-reference this data with administrative data. Future studies should examine the differential impacts on satisfaction according to type of illness or other sociodemographic factors.
Pediatric home-based care is preferred by patients and their families. Remaining in their homes and staying in their environments contributes to patient-centered care, while empowering the patients and their families in the care and control of their illnesses. In keeping with the evidence already published, this study shows that home-based hospitalization is associated with an improvement in the quality of life of the child and the family and with a potential decrease in the demand for hospital services. Telemonitoring tools are one of the essential elements that make this possible. The high degree of acceptance of the devices—thermometer, pulse oximeter, blood pressure monitor, and scale—is an opportunity to study the implementation of new tools that reinforce and offer guarantees of certain types of care.
In terms of the impact on clinical outcomes, future studies should determine whether, as with the adult population, clinical outcomes are comparable to or better than those of conventional hospitalization by analyzing the impact on readmission or mortality with respect to the usual path of hospitalization. Likewise, we must study the cost-effectiveness of this type of intervention, by comparing the cost of travel and that of the devices with the savings derived from the reduction of days in hospital, reduction of conventional hospitalization costs, and the increase in hospital capacity resulting from the freeing up of beds.
Self-administered study survey.
This study was conducted with the support of the Secretary of Universities and Research of the Department of Business and Knowledge of the Generalitat de Catalunya.
None declared.