Providing comprehensive health care to children with chronic illness

A program that provides comprehensive services to families of chronically ill children may satisfy previously unmet needs, especially in the areas of psychological and social concerns. Chronic illness in children includes a wide variety of conditions such as asthma, diabetes, sickle cell anemia, leukemia and juvenile rheumatoid arthritis. Of 209 chronically ill children up to 12 years old, half were assigned to Pediatric Home Care (PHC), a comprehensive care program, and half received standard care. PHC included care in the home or other convenient location, coordination with specialists as needed, patient and family education and counseling, and liaison with social services or other outside agencies. The mothers were interviewed before the study and six months and one year later. The most significantly improved area of service with PHC was having someone listen to concerns about caring for a sick child. Coordination with other agencies was also better under the PHC plan.
Objectives. To test whether a program of outreach and comprehensive health care for children with chronic disorders provides more complete care and reduces unmet health needs compared with traditional care. Design. A pretest-posttest randomized control trial. Setting. An inner-city municipal teaching hospital. Sample. Two hundred nineteen systematically enrolled mothers of children with diverse chronic physical health conditions. Interventions. A comprehensive outreach program, Pediatric Home Care (PHC), contrasted with Standard Care. Measurements and Results. Nine elements of comprehensive care established in the literature as components of a basic package of care for those with chronic conditions. The PHC intervention addressed gaps in services and improved both the acquisition and maintenance of elements of comprehensive care. Conclusions. These data suggest mechanisms through which comprehensive care programs may contribute to the improvement in psychological and social outcomes previously reported for those in the PHC intervention. Pediatrics 1994;93:602-607; unmet health needs, chronic illness, comprehensive care, home care, intervention, randomized trial.