An evaluation of the costs and consequences of Children Community Nursing teams.

AIMS: Recent years have seen an increasing shift towards providing care in the community, epitomised by the role of Children's Community Nursing (CCN) teams. However, there have been few attempts to use robust evaluative methods to interrogate the impact of such services. This study sought to evaluate whether reduction in secondary care costs, resulting from the introduction of 2 CCN teams, was sufficient to offset the additional cost of commissioning. METHODS: Among the potential benefits of the CCN teams is a reduction in the burden placed on secondary care through the delivery of care at home; it is this potential reduction which is evaluated in this study via a 2-part analytical method. Firstly, an interrupted time series analysis used Hospital Episode Statistics data to interrogate any change in total paediatric bed days as a result of the introduction of 2 teams. Secondly, a costing analysis compared the cost savings from any reduction in total bed days with the cost of commissioning the teams. This study used a retrospective longitudinal study design as part of the transforming children's community services trial, which was conducted between June 2012 and June 2015. RESULTS: A reduction in hospital activity after introduction of the 2 nursing teams was found, (9634 and 8969 fewer bed days), but this did not reach statistical significance. The resultant cost saving to the National Health Service was less than the cost of employing the teams. CONCLUSION: The study represents an important first step in understanding the role of such teams as a means of providing a high quality of paediatric care in an era of limited resource. While the cost saving from released paediatric bed days was not sufficient to demonstrate cost-effectiveness, the analysis does not incorporate wider measures of health care utilisation and nonmonetary benefits resulting from the CCN teams.

Paediatric palliative care: a review of needs, obstacles and the future.

AIM: This literature review offers a response to the current paediatric palliative care literature that will punctuate the need for a framework (i.e. the three world view) that can serve as an evaluative lens for nurse managers who are in the planning or evaluative stages of paediatric palliative care programmes. BACKGROUND: The complexities in providing paediatric palliative care extend beyond clinical practices to operational policies and financial barriers that exist in the continuum of services for patients. EVALUATION: This article offers a review of the literature and a framework in order to view best clinical practices, operational/policy standards and financial feasibility when considering the development and sustainability of paediatric palliative care programmes. KEY ASPECTS: Fifty-four articles were selected as representative of the current state of the literature as it pertains to the three world view (i.e. clinical, operational and financial factors) involved in providing paediatric palliative care. CONCLUSION: In developing efficient paediatric palliative care services, clinical, operational and financial resources and barriers need to be identified and addressed. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management plays a crucial role in addressing the clinical, operational and financial needs and concerns that are grounded in paediatric palliative care literature.

[Health insurance expenses for children in the first five years of life - a cohort-based analysis]. / Ausgaben einer Krankenkasse für Kinder in den ersten fünf Lebensjahren - eine kohortenbasierte Analyse.

INTRODUCTION: The development of paediatrics is characterised by several changes in the past few years, concerning, in particular holistic treatments or preventive check-ups, but also the transfer of treatment from the inpatient to the outpatient sector. There are no reference values for assessing emerging health insurance expenses. The aim of this study was to obtain a frame of reference for the costs of the treatment for neonates, infants, and young children using the example of the expenditures of one health insurance fund. METHODS: The individual health insurance expenditures were analysed for the first five years of life of children insured with the AOK PLUS in Saxony, Germany, in 2005. Costs of hospital treatment, ambulatory care, remedies, tools, medicines and care were included. RESULTS: The costs per insured child and year amounted to approximately 1,277 Euro (N = 11,147), with the highest costs arising in the first two years. 858 Euro were spent annually for an "average" child; 5,691 Euro per year incurred for a child with special medical needs. DISCUSSION: The present cost analysis describes both the height and structure of a health insurance's spendings on children within the first five years of their life in consideration of regional medical care offers. The question of whether this analysis provides valid reference values for other health insurances or other service areas will have to be answered by other analyses.

[Insufficient funding of nursing service in paediatrics. The case of the DRG E77C]. / Unterfinanzierung des Pflegedienstes in der Kinderheilkunde. Eine exemplarische Betrachtung der DRG E77C.

For most of the existing German Diagnosis Related Groups (G-DRG) the German generalised compensation system for medical services in hospitals does not distinguish between children and adults. There is a risk of the cost of high-maintenance paediatric patients not being covered. This problem is tried to be solved by implementing a split based on the patient's age. Thus children under the age of one year will be classified to a different DRG than older patients with the same diagnosis. A study of working time combined with an analysis of the so-called "Pflegepersonalregelung-Minuten" carried out by the Ernst-Moritz-Arndt University of Greifswald exemplarily shows the different intenseness of care between paediatric and adult patients. Furthermore, the different intenseness of care correlates with the labour cost of the university hospital and shows the extensions of the shortfall for the most profitable DRG based on guidelines of the "Institut für das Entgeltsystem im Krankenhaus" (Institute for the compensation system in hospitals, InEK). Last but not least it discusses if the age-splitting planned for the 2008 DRG-Catalogue might improve the financial situation. Moreover the authors point out possibilities for a proper compensation for paediatrics in the G-DRG system.