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’ 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. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> What is Known: • Multidisciplinary pediatric home care models integrated within tertiary care institutions are effective in managing children with medical complexity. • Caregivers frequently report high levels of unmet needs due to the intensity and complexity of home caregiving responsibilities. </entry> </row> <row> <entry align="left" nameend="c2" namest="c1"> What is New: • Pediatric home care services are associated with reduced pediatric intensive care unit admissions and hospitalizations among children with medical complexity. • The identified caregivers’ unmet needs inform the optimization of pediatric home care services and guide future intervention development. </entry> </row> </tbody> </tgroup> </Table>

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

期刊论文
发表日期：

2026年1月2日

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Kyua Kim,
Eunyong Kim,
Hyunjin Seo,
Myoung Sun Gong,
Hooyun Lee,
Seung Yeon Kwon,
Eun Kyoung Choi

摘要

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’ 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.

What is Known:

• Multidisciplinary pediatric home care models integrated within tertiary care institutions are effective in managing children with medical complexity.

• Caregivers frequently report high levels of unmet needs due to the intensity and complexity of home caregiving responsibilities.

What is New:

• Pediatric home care services are associated with reduced pediatric intensive care unit admissions and hospitalizations among children with medical complexity.

• The identified caregivers’ unmet needs inform the optimization of pediatric home care services and guide future intervention development.