Background: Pediatric home hospitalization improves the quality of life of children and their families, involving them in their children’s care, while favoring the work-life balance of the family. In this context, technology guarantees accessibility to assistance, which provides security to users. From the perspective of the health care system, this could lower the demand for hospital services and reduce hospitalization costs. Objective: This study aimed to assess families’ degree of satisfaction and acceptability of pediatric telehomecare and explore the clinical characteristics of children benefiting from the program. Methods: A total of 95 children and their families participated in the home-hospitalization pilot program operated by Sant Joan de Déu Hospital in Barcelona, Spain. Families were visited once a day and patients were monitored using a kit consisting of a scale, a thermometer, a pulse oximeter, and a blood pressure monitor. Data on parental experience, satisfaction, safety, and preference for care was collected by means of a questionnaire. Data about the children’s characteristics were collected from medical records. Descriptive and comparative statistics were used to analyze the data. Results: A total of 65 survey respondents expressed very high levels of satisfaction. Families reported their experiences as being very positive, preferring home hospitalization in 94% (61/65) of cases, and gave high scores regarding the use of telemonitoring devices. The program did not record any readmissions after 72 hours and reported a very low number of adverse incidents. The user profile was very heterogeneous, highlighting a large number of respiratory patients and patients with infections that required endovenous antibiotic therapy. Conclusions: Pediatric home hospitalization through telemonitoring is a feasible and desirable alternative to traditional hospitalization, both from the perspective of families and the hospital. The results of this analysis showed a very high degree of satisfaction with the care received and that the home-based telemonitoring system resulted in few adverse incidents.

Background: Although home hospitalization has been a well-known and widespread practice for some time in the adult population, it has not been the same case in the pediatric setting. Simultaneously, telemedicine tools are a facilitator of the change in the health care model, which is increasingly focused on home care. In a pioneering way in Spain, the in-home hospitalization program of the Hospital Sant Joan de Déu in Barcelona allows the child to be in their home environment at the time they are being monitored and clinically followed by the professionals. Besides being the preferred option for families, previous experience suggests that pediatric home hospitalization reduces costs, primarily thanks to savings on the structural cost of the stay. Objective: The aim of this study is to compare the average cost of a discharge by tele–home care with the usual care and to analyze the main drivers of the differential costs of both care models. Methods: A cost-minimization analysis is conducted under a hospital’s perspective, based on observational data, and estimated retrospectively. A historical control group of similar patients in terms of clinical casuistry to children hospitalized at home was used for comparison. Results: A 24-hour stay at the hospital costs US $574.19, while the in-home hospitalization costs US $301.71 per day, representing a saving of almost half (48%) of the cost compared to usual care. The main saving drivers were the personnel costs (US $102.83/US $284.53, 35.5% of the total), intermediate noncare costs (US $6.09/US $284.53, 33.17%), and structural costs (US $55.16/US $284.53, 19.04%). Home hospitalization involves a total stay 27.61% longer, but at almost half the daily cost, and thus represents a saving of US $176.70 (9.01%) per 24-hour stay. Conclusions: The cost analysis conducted under a hospital perspective shows that pediatric tele–home care is 9% cheaper compared to regular hospital care. These results motivate the most widespread implementation of the service from the point of view of economic efficiency, adding to previous experiences that suggest that it is also preferable from the perspective of user satisfaction.

SJD a Casa is an acute pediatric hospital-at-home program that was initiated in 2019. For a thorough understanding of acute pediatric homecare programs, an analysis of all related factors, including the medical, social, and economic aspects as well as the family’s experience, is essential. However, no previous study has attempted a comprehensive evaluation of this topic in relation to a complex program such as ours (in terms of the diseases and treatments offered). In this study, we aimed to finely characterize the population that opts for pediatric homecare programs and obtain a thorough understanding of the families’ needs, which will improve our understanding of the program and potentially reveal possible deficiencies. This prospective quantitative and qualitative study involved collection of ordinal data as well as statements made by the caregivers of patients undergoing homecare. A total of 372/532 families were asked to answer two independent questionnaires (preadmission and postadmission) that evaluated their socioeconomic characteristics; expectations and experiences; and factors influencing the preference for homecare. The results were presented as frequencies and comparisons (Fisher’s exact test). The families had an adequate social network and a less-than-expected workload, and most families responded that they would have repeated the experience despite the workload. The expectations regarding the caregiver’s well-being at home were better than the actual situation, since some caregivers experienced anxiety or fear. The rating for homecare was better than that for the inpatient care offered before the homecare transfer. Families included in the program were content with the homecare program and mostly responded that they would repeat the experience if needed. Although the duration of the program was short-term, some caregivers may experience symptoms of burnout like anxiety, which should be taken into consideration. Despite its limitations, this study offers the possibility of improving our service portfolio by focusing on vulnerable families’ access to the program and the caregiver’s risk of burnout.

Background: Hospital Sant Joan de Déu (Barcelona) initiated a pediatric acute home-hospitalization program. Due to high patient turnover and the health staff's lack of planning training, daily scheduling was a time-consuming task. Home-hospitalization planning is a vehicle routing problem that can be solved with a technological solution. It was therefore decided to evaluate the efficacy and necessity of the SmartMonkey.io planner.Objectives: To compare traditional manual route planning with a route optimizer, and to evaluate the technical feasibility of the implementation of a route planner into a homecare program.Methods: Eight participants (experienced homecare staff and inexperienced hospital staff) were included. Personal interviews were performed to assess their eagerness to try a technological solution to the planning problem. Objective benefits including reduced travel time (time planning, distance traveled, and time traveled) were evaluated. Paired t-test, t-test, and Pearson's correlation were used to compare manual and route planner scheduling. Participants then answered a questionnaire to assess planning difficulty and the acceptance of the route planner.Results: Homecare staff were initially reluctant to use the technology. Significant differences (P < 0.0001) in three variables were found between manual planning and the route planner. A moderate correlation between time planning and plan difficulty (r = 0.59, P < 0.0001) was found with manual planning but not with the route planner. All route planner schedules saved time and distance. No significant differences were found between expertise and planning method. It was noted that it was easy to create plans with the route planner, while difficulty with manual planning increased as more locations were added. All participants evaluated the route planning tool favorably.Conclusions: Route-planning technology saved planning time and generated better plans than manual planning. The route planner's learning curve was fast and results were obtained in the same amount of time regardless of difficulty and expertise. SmartMonkey.io also has the potential to reduce internal and environmental costs and increase staff productivity.

Purpose: To have a thorough understanding of an acute pediatric homecare program, it is essential to analyze all factors related to the matter: medical, social, economic, and families’ experience. No studies have been found describing profusely this topic in such a complex program like ours (considering diseases and treatments offered). With this study, we will obtain a fine population characterization and families’ needs understanding. This will contribute to a better knowledge of our program and the detection of its possible deficiencies.Methods: This is a prospective quantitative and qualitative study. 372/532 families are asked to answer two independent questionnaires (preadmission and postadmission), aimed to: understand their socioeconomic characteristics; assess families’ expectations and experience; and identify factors influencing the homecare preference. Results are presented in frequencies and comparisons (Fisher’s exact test). Results: Families have an adequate social network; workload is less than expected and most families would repeat the experience despite it; expectations regarding caregiver’s well-being at home were better than the actual situation, as some experienced anxiety or fear; and rating is better in homecare compared with inpatient care. Conclusions: Despite limitations (participants’ voluntariness to respond the surveys and lack of inpatient hospitalization’s socioeconomic data to compare with homecare), this study offers the possibility of improving our service portfolio, focusing on vulnerable families’ access to the program and caregiver’s risk of burnout.

Background: Hospital-at-home (HAH) programs deliver hospital-level care in patients’ homes, improving satisfaction and optimizing resource use. While widely adopted in adults, pediatric HAH remains limited. At Sant Joan de Déu Hospital (Barcelona, Spain), the pediatric HAH program for acutely ill children has expanded to include more clinically complex cases. Family involvement is essential, as caregivers are trained to administer treatments, monitor clinical status, and support telematic follow-ups, supporting the healthcare team’s workload. Objective: To identify patient characteristics influencing healthcare workload and develop a predictive model to enhance resource allocation. Methods: This single-center, prospective cohort study included all patients admitted to the pediatric HAH program for one year. Primary variables were caregiver training time, home visiting time, patient age, type of care provided, and clinical complexity. Secondary variables included referral specialty and team composition. Data were collected using digital time-tracking, manual records, and clinical databases. Analyses included Kruskal–Wallis and Dunn’s multiple comparison tests. Results: All variables showed significant differences in training and visiting times. Training time ranged from 19 to 157 min; visiting time from 6.2 to 157 min. A predictive model using five key variables estimated visiting time, and another model based on care type estimated training time were created. Conclusions: Patient characteristics and caregiver involvement significantly affect direct care workload. These findings can inform strategies to optimize staffing and scale pediatric HAH programs effectively.