Caregiver priorities and healthcare outcomes in a pediatric home care service for children with medical complexity: a quasi-experimental study

Abstract

This study aimed to evaluate the outcomes of a pediatric home care service (PHCS) provided to children with medical complexity (CMC) and to identify and prioritize the unmet care needs of their caregivers. This quasi-experimental study was conducted from April 2024 to January 2025 among 66 caregivers of CMC who had received a PHCS for more than 1 month at a tertiary hospital in South Korea. Cross-sectional analysis examined PHCS provision and caregivers&apos; unmet needs using the Borich Needs Assessment Model, Importance-Performance Analysis, and the Locus for Focus Model, while retrospective longitudinal analysis of electronic medical records (EMR) and health insurance data (HIRA) assessed changes in healthcare utilization before and after PHCS participation. Most children in the PHCS required multiple medical supports, including gastrostomy feeding (91%), suctioning (96%), and mechanical ventilation (68%). PHCS involved physician (median 3/year), nurse (13/year), and home therapy visits (22.5/year). Phone consultations were made available during business hours. After the PHCS began, there were significant decreases in pediatric intensive care unit admissions (54.5 to 19.7%, p < 0.001), hospitalizations (89.4 to 69.7%, p = 0.015), and the number of outpatient department visits (11.7 +/- 3.8 to 10.4 +/- 2.8, p = 0.006). The caregivers were highly satisfied, but the key unmet needs included emergency room communication, education on disease prevention, and referral coordination. Conclusion: PHCS are associated with decreased healthcare utilization among CMC. Although caregivers reported high satisfaction with the PHCS, the identified unmet needs provide evidence for enhancing service quality and inform future intervention research.