Access and Quality of Pediatric Home Healthcare: A Systematic Review

Despite the rising prevalence of children with medical complexity who need extensive medical care at home, the literature evaluating pediatric home healthcare has not been well summarized. Our objective was to systematically review the evidence-base of pediatric home healthcare to understand what is currently know about access and quality of home healthcare for children. Pubmed, Ovid Medline, Embase, CINAHL, Cochrane Library, Proquest Dissertations and Theses Global were searched for studies in the United States, United Kingdom, Canada, and Australia English publications (1980-2020) regarding children (<= 18 years) using shift-based home healthcare services. Blinded independent review was conducted followed by extraction of study characteristics including how each study examined access and/or quality, which was categorized using the National Academy of Medicine quality dimensions. Of 9533 abstracts, 101 were included. Most were US (82%) and regional (72%) studies. Half (54%) focused on home nursing followed by home services generally (43%). The majority (77%) evaluated access and patient-family centeredness (62%); their results identified consistent limitations in access and quality resulting in negative impacts on patients and families. Less than 20% of publications addressed safety, effectiveness or equity. Bias scoring found that quantitative studies were universally weak, but qualitative studies were mostly moderate or strong. Results are limited by design heterogeneity and exclusion of training research. While research in pediatric home healthcare has increased, studies remain observational and rarely evaluate quality in reproducible ways. More rigorous measures and interventional research are needed to improve this healthcare sector for children.