Organisation of paediatric hospital care in Belgium: current situation and options for reform
- Resource Type
- Authors
- Lefevre, Mélanie
- Source
- Subject
- Hospital Bed Capacity
Health Care Reform
R358
WX 100 Hospitals and Other Health Facilities -- General works
2019-50-02
Home Care Services, Hospital-Based
Continuity of Patient Care
Child, Hospitalized
- Language
- English
359 p. ill., LIST OF FIGURES 10 -- LIST OF TABLES 15 -- LIST OF ABBREVIATIONS .17 -- SCIENTIFIC REPORT 23 -- 1 INTRODUCTION .23 -- 1.1 THE CHANGING ROLE OF HOSPITAL CARE FOR CHILDREN .23 -- 1.2 OBJECTIVE AND SCOPE OF THE REPORT .24 -- 1.3 RESEARCH OBJECTIVES AND METHODS 25 -- PART I: THE ORGANISATION AND ACTIVITY PROFILE OF PAEDIATRIC SERVICES IN BELGIUM 27 -- 2 THE LEGAL FRAMEWORK OF PAEDIATRIC HOSPITAL CARE IN BELGIUM 27 -- 2.1 THE SYSTEM OF PAEDIATRIC CARE IN BELGIUM .28 -- 2.2 THE LEGAL FRAMEWORK OF PAEDIATRIC HOSPITAL CARE 28 -- 2.2.1 Paediatric service .29 -- 2.2.2 Care programme for children (2006) 30 -- 2.2.3 Care programme for children (2014) 31 -- 2.2.4 The specialised care programme for paediatric haemato-oncology 35 -- 2.2.5 Paediatric liaison function 37 -- 2.2.6 Paediatric network 38 -- 2.2.7 Intensive care for children 39 -- 2.2.8 Conventions 39 -- 2.3 FINANCING 39 -- 2.3.1 Paediatric service and paediatric intensive care 39 -- 2.3.2 Paediatric liaison function 41 -- 2.3.3 Conventions 41 -- 3 LANDSCAPE AND ACTIVITY PROFILE OF SERVICES PROVIDING PAEDIATRIC CARE IN BELGIAN HOSPITALS 41 -- 3.1 INTRODUCTION .43 -- 3.2 METHODS 43 -- 3.3 CURRENT LANDSCAPE OF PAEDIATRIC SERVICES IN BELGIAN HOSPITALS 44 -- 3.4 DAY CARE FOR CHILDREN 51 -- 3.4.1 Selection of stays .51 -- 3.4.2 Distribution of day-care stays .51 -- 3.4.3 Age profile of patients 54 -- 3.4.4 Clinical profile of patients .54 -- 3.5 INPATIENT PAEDIATRIC SERVICES .56 -- 3.5.1 Selection of stays .56 -- 3.5.2 Children and paediatric services 57 -- 3.5.3 Age profile of patients in paediatric services .63 -- 3.5.4 Length of stay for patients in paediatric services .64 -- 3.5.5 Clinical profile of patients .66 -- 3.5.6 Respiratory syncytial virus (RSV) 75 -- 3.6 PAEDIATRIC INTENSIVE CARE UNITS 79 -- 3.6.1 Selection of stays .79 -- 3.6.2 Children in intensive care units .79 -- 3.6.3 Adolescents in intensive care units .82 -- 3.6.4 Age profile of patients 84 -- 3.6.5 Clinical profile of patients .84 -- 4 OCCUPANCY RATE IN SERVICES PROVIDING PAEDIATRIC CARE IN BELGIAN HOSPITALS 87 -- 4.1 OBJECTIVE 87 -- 4.2 METHODS 88 -- 4.2.1 Selection of stays .88 -- 4.2.2 Computation of bed occupancy rates in paediatric services and bed use in other inpatient units .88 -- 4.3 BED OCCUPANCY RATE AND BED USE AT THE NATIONAL LEVEL 90 -- 4.3.1 Daily average bed occupancy rate for 2017 and 2018 .90 -- 4.3.2 Bed occupancy rate in 2018 subdivided by age groups 92 -- 4.3.3 Bed occupancy rate in 2018 subdivided by clinical profile of the patients 95 -- 4.3.4 Bed use outside paediatric services 99 -- 4.4 BED OCCUPANCY RATE AT THE SITE LEVEL 101 -- 4.4.1 Mean, minimum and maximum occupancy rate 101 -- 4.4.2 Number of days with high occupancy rates .107 -- 4.4.3 Number of days with low occupancy rates 108 -- 4.5 BED OCCUPANCY RATE AT THE NETWORK LEVEL 110 -- 4.5.1 Daily average bed occupancy rate for 2018 110 -- 4.5.2 Number of days with high and low occupancy rates 115 -- 4.6 LINK BETWEEN BED OCCUPANCY RATE AND SURVEY RESPONSES .118 -- 5 IMPACT AND MANAGEMENT OF SEASONAL PEAKS: RESULTS FROM AN ONLINE SURVEY 123 -- 5.1 OBJECTIVE .125 -- 5.2 METHODS 125 -- 5.2.1 Data collection process 125 -- 5.2.2 Data collection tool and questionnaire 125 -- 5.2.3 Analysis 126 -- 5.3 RESULTS .127 -- 5.3.1 Response rate .127 -- 5.3.2 Characteristics of hospitals and paediatric services 128 -- 5.3.3 Impact of seasonal peaks in paediatric services 132 -- 5.3.4 Hospital level measures to cope with seasonal peaks in paediatric services 137 -- 5.3.5 General policy measures to cope with seasonal peaks in paediatric services 140 -- 5.3.6 Loco-regional networks 147 -- 5.3.7 Impact of future trends 148 -- PART II: TRANSMURAL CARE FOR CHILDREN IN BELGIUM .151 -- 6 TRANSMURAL CARE MODEL OF THE PAEDIATRIC LIAISON TEAMS IN BELGIUM .151 -- 6.1 OBJECTIVE .153 -- 6.2 METHODS 153 -- 6.2.1 Data collection tool 153 -- 6.2.2 Data collection process 153 -- 6.2.3 Analysis 153 -- 6.3 RESULTS .154 -- 6.3.1 How does a paediatric liaison team work? 154 -- 6.3.2 Target population 157 -- 6.3.3 Type of transmural care .161 -- 6.3.4 Staff numbers, qualifications and roles 168 -- 6.3.5 Funding of paediatric liaison teams .169 -- 6.3.6 Limitations and problems indicated by the paediatric liaison teams 169 -- 6.3.7 The paediatric liaison function as a model for transmural care .172 -- 7 FACTORS INFLUENCING THE IMPLEMENTATION OF TRANSMURAL PAEDIATRIC CARE AND POINT OF VIEW OF STAKEHOLDERS IN BELGIUM 174 -- 7.1 OBJECTIVE .174 -- 7.2 METHODS 174 -- 7.3 GENERAL OPINIONS AND ATTITUDES TOWARDS PAEDIATRIC CARE .175 -- 7.4 OPINIONS AND ATTITUDES TOWARDS TRANSMURAL PAEDIATRIC CARE 176 -- 7.4.1 Terminology to describe transmural paediatric care 176 -- 7.4.2 Target population 177 -- 7.4.3 Transmural paediatric care will further erode paediatric hospital care in Belgium 177 -- 7.4.4 Impact on costs 177 -- 7.5 FACTORS INFLUENCING THE IMPLEMENTATION OF TRANSMURAL PAEDIATRIC CARE 178 -- 7.5.1 Financing 178 -- 7.5.2 Human resources 180 -- 7.5.3 Other factors to consider in the context of transmural paediatric care 183 -- 7.6 LESSONS FROM OTHER INITIATIVES 183 -- 7.6.1 Conventions .184 -- 7.6.2 Lessons from initiatives for transmural care (for adults) 186 -- 7.7 DESIGN AND EVALUATION OF FUTURE PAEDIATRIC PILOT PROJECTS 190 -- 7.7.1 Target population for transmural paediatric care 190 -- 7.7.2 Coordination .192 -- 7.7.3 Funding 193 -- 7.7.4 Distribution of medicines 195 -- 7.7.5 Setting .196 -- 7.7.6 Role of the patient and his family 196 -- 7.7.7 Uniform communication across healthcare providers and/or organisations 198 -- 7.7.8 Other aspects to consider when designing transmural paediatric care .198 -- PART III: INTERNATIONAL COMPARISON OF TRANSMURAL CARE MODELS FOR CHILDREN .200 -- 8 HOSPITAL AT HOME FOR CHILDREN IN FRANCE 202 -- 8.1 OVERVIEW OF HOSPITAL-AT-HOME SERVICES IN FRANCE 203 -- 8.1.1 Historic perspective 203 -- 8.1.2 Current legal framework .204 -- 8.1.3 HAH structures 206 -- 8.1.4 Activity volume 206 -- 8.1.5 Workforce 207 -- 8.1.6 HAH episode 207 -- 8.1.7 Types of care activities 208 -- 8.1.8 Selection of patients .209 -- 8.1.9 Financing 210 -- 8.1.10 Coordination with home nursing care services 212 -- 8.1.11 Evaluation / quality indicators .212 -- 8.1.12 Ongoing reform 213 -- 8.2 PAEDIATRIC ACTIVITY IN HAH IN FRANCE 215 -- 8.3 OVERVIEW OF SELECTED CASE STUDIES .219 -- 8.3.1 Semi-structured interviews with a selection of organisations .219 -- 8.3.2 Brief overview of selected HAH structures 220 -- 8.3.3 Transversal analysis of key topics 229 -- 9 HOSPITAL IN THE HOME FOR CHILDREN IN AUSTRALIA .238 -- 9.1 OVERVIEW OF HOSPITAL IN THE HOME SERVICES IN THE STATE OF VICTORIA (AUSTRALIA) .239 -- 9.1.1 Historic perspective 239 -- 9.1.2 Legal framework .240 -- 9.1.3 HITH structures 241 -- 9.1.4 Workforce 244 -- 9.1.5 HITH episode 245 -- 9.1.6 Types of care 246 -- 9.1.7 Selection of patients .247 -- 9.1.8 Financing 248 -- 9.1.9 Coordination with home nursing care .249 -- 9.1.10 Evaluation / quality indicators .249 -- 9.2 OVERVIEW OF HOSPITAL IN THE HOME SERVICES IN THE STATE OF NEW SOUTH WALES (AUSTRALIA) 250 -- 9.2.1 Historic perspective 250 -- 9.2.2 Legal framework .251 -- 9.2.3 HITH structures 251 -- 9.2.4 Workforce 252 -- 9.2.5 HITH episode 253 -- 9.2.6 Types of care 254 -- 9.2.7 Selection of patients .255 -- 9.2.8 Financing 255 -- 9.2.9 Coordination with home nursing care .256 -- 9.2.10 Evaluation / quality indicators .256 -- 9.3 OVERVIEW OF SELECTED CASE STUDIES .257 -- 9.3.1 Semi-structured interviews with a selection of organisations .257 -- 9.3.2 Brief overview of the selected paediatric HITH programmes .258 -- 9.3.3 Transversal analysis of key topics 260 -- 10 TRANSMURAL PAEDIATRIC CARE IN THE NETHERLANDS 268 -- 10.1 TWO REFORMS SHAPED THE CURRENT HEALTHCARE SYSTEM IN THE NETHERLANDS 269 -- 10.1.1 Main characteristics of the 2006 health insurance reform 269 -- 10.1.2 Main characteristics of the 2015 long-term care reform 269 -- 10.2 HISTORICAL PERSPECTIVE OF TRANSMURAL CARE FOR ADULTS 270 -- 10.2.1 From temporary projects to a clear policy objective 271 -- 10.2.2 Organisation of transmural care for adults 272 -- 10.3 TRANSMURAL CARE FOR CHILDREN 273 -- 10.3.1 From a fragmented policy context to a comprehensive approach for transmural care for children 273 -- 10.3.2 Strategies to ensure quality of care .279 -- 10.3.3 Funding of transmural care for children .280 -- 10.3.4 Education and training of paediatric nurses .282 -- 10.4 OVERVIEW OF SELECTED CASE STUDIES .283 -- 10.4.1 Semi-structured interviews with a selection of organisations .283 -- 10.4.2 ExpertCare 283 -- 10.4.3 KinderThuisZorg .285 -- PART IV: REVIEW OF THE LITERATURE ON PAEDIATRIC HOME THERAPY 287 -- 11 REVIEW OF THE LITERATURE ON PAEDIATRIC HOME THERAPY .287 -- 11.1 INTRODUCTION 287 -- 11.2 METHODS 287 -- 11.2.1 Research question 287 -- 11.3 LITERATURE SEARCH AND SELECTION 289 -- 11.3.1 Quality appraisal and data extraction 289 -- 11.3.2 Statistical analysis .290 -- 11.3.3 GRADE 290 -- 11.4 RESULTS .290 -- 11.4.1 Overview of selected studies 290 -- 11.4.2 Characteristics of home care 302 -- 11.4.3 Effect on outcomes by type of intervention 314 -- 11.5 DISCUSSION .329 -- APPENDICES 332 -- REFERENCES 339