Hospital-Based Paediatric Home Health Care: The Peculiar Experience of a Multidisciplinary Service in Italy

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Contarini, E. Castagnola, V. Morsellino This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8808940/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Managing paediatric medical complexity requires models that integrate hospital expertise with home care. We describe the 25-year experience of the IRCCS Giannina Gaslini (IGG) with its Hospital-Based Home Care (HBHC) programme. Methods We analysed the multidisciplinary HBHC model through four high-tech clinical cases: chronic respiratory failure, paediatric oncology, congenital haemostasis, and rare inflammatory syndromes. Results The model enabled the safe home management of mechanical ventilation and complex infusion therapies. Results highlight a reduction in hospital bed occupancy and improved family wellbeing, filling the gap in specialized local support. Conclusions The IGG HBHC service represents a scalable model that ensures continuity of care between hospital and home, optimizing resources and improving the quality of life for children with medical complexity. Paediatric Home Health Care Medical Complexity Multidisciplinary Team Hospital-Based Care Quality of Life Healthcare Policy Introduction The diagnosis and treatment of a wide range of diseases, especially rare and/or those with severe prognosis, represent a highly stressful event, not only for the patient but also for the entire family [ 1 , 2 ]. The disruptive impact of illness is increased by the frequency and length of hospital admissions, as well as by crowded outpatient visits. It is well established that a child's mood and socialization are severely affected by prolonged clinical environments [ 3 ]. Paediatric Home Health Care (PHHC) is a vital, specialized system that delivers medical treatments, services, equipment, and supplies within a patient’s home and community. It aims to treat chronic conditions, disabilities, and acute illnesses while maintaining the family unit [ 4 ]. The IRCCS Istituto Giannina Gaslini (IGG) is a tertiary care paediatric hospital providing comprehensive sub-specialty care located in Genoa, Liguria Region (northwest Italy). Approximately 60% of IGG patients originate from outside Liguria; this "health migration" occurs because patients seek high-quality care often unavailable near their homes. Since April 2000, a Hospital-Based Home Care (HBHC) programme has been operational for patients residing in the metropolitan Genoa area (approx. 250 km²). Service Organisation Staff: The HBHC team consists of two senior paediatricians with extensive experience in onco-haematology, respiratory diseases, and palliative care, alongside four specialized paediatric nurses. The service operates seven days a week: 7:00 a.m. to 8:00 p.m. (Monday–Friday) and 8:00 a.m. to 3:00 p.m. (Saturdays and holidays). Within these working hours and with a full staff, 8–10 home visits per day can be guaranteed. Take-in-charge Process: An in-hospital case manager contacts the HBHC team to define home care eligibility and develop a prospective plan for medically necessary care. Medical issues, non-medical needs, and the goals of both the patient and family are evaluated in depth. The official reference at the time of handover is represented by the discharge letter as well as the clinical diary present in the electronic medical record, both shared within the same software and accessible from any workstation. This is followed by an interview with the caregivers to explain service modalities and emphasize the strict cooperation between the HBHC and in-hospital teams, thereby reducing any parental feelings of abandonment. Prescriptions, therapy verification (e.g., chemotherapy, transfusions, supportive care), characteristics and description of the devices, and clinical diaries follow the same electronic pathways used within the hospital. Illustrative Clinical Cases Case 1 Technology-Dependent Child (Respiratory) Patient: 16-year-old boy. Diagnosis: Congenital hypomagnesemia requiring long-term tracheostomy and mechanical ventilation. Home Care Needs: 24-hour skilled care due to technology dependence. Nurses provide training and supervision to enable family autonomy in drug administration and device management. Scheduled bi-weekly medical evaluations focus on preventing respiratory infections and pressure ulcers. Outcome: Maintenance of stable respiratory function and safe G-tube feeding while minimizing Emergency Department visits. Case 2 Malignant Haematological Disease Patient: 10-year-old boy. Diagnosis: Acute Lymphoblastic Leukaemia (ALL). Home Care Needs: During the consolidation phase, the patient received treatment via an ambulatory elastomeric pump to improve quality of life and reduce the risk of hospital-acquired infections. The family was trained to recognize "red flags". Outcome: Safe administration of medication and reduced hospital bed occupancy, allowing the patient to remain in a familiar environment. Case 3 Severe Congenital Haemostasis Management Patient: 5-month-old girl. Diagnosis: Congenital severe Protein C deficiency with bilateral retinal thrombosis. Home Care Needs: Subcutaneous Protein C infusion via an off-label micro-infusion device (insulin pump) to maintain stable plasma levels. Outcome: Successful stabilization of Protein C levels, allowing the patient to attend a specialized rehabilitation centre. Case 4 Congenital Inflammatory Syndrome Patient: 16-year-old girl. Diagnosis: SAVI Syndrome (STING-associated vasculopathy). Home Care Needs: Treatment of Invasive Pulmonary Aspergillosis (IPA) via thrice-weekly i.v. liposomal amphotericin-B. Management included Non-Invasive Ventilation (NIV) monitoring. Outcome: Stabilization of the infection and prevention of inflammatory flares, serving as a bridge to lung transplantation. Discussion The goals of PHHC are multifaceted: improving the child's quality of life, preventing unplanned readmissions [ 5 ], and supporting the family’s desire for normalcy during recovery [ 6 ]. Our experience with technology-dependent children aligns with recent Italian multicentre evidence suggesting that home-based management of complex devices, such as tracheostomies and gastrostomies, is not only feasible but safe when managed by specialized teams [ 7 ]. This hospital-centred approach mitigates the risks typically associated with home care. Furthermore, the integration of specialized nursing and medical oversight acts as a fundamental pillar for clinical efficacy, as highlighted by recent perspectives on Italian paediatric care coordination [ 8 ]. An additional significant advantage is the improved use of beds, especially out-patient beds. In our practice, hospital occupancy for specialties represented in these cases is always close to 100%, making home care indispensable. Financial advantages also emerge, increasing with the complexity of the cases treated, combined with a reduction in the use of hospital resources [ 9 , 10 ]. Conclusions Despite the positive outcomes observed, the HBHC model is currently restricted to the metropolitan area of Genoa. This disparity in access reflects a broader national challenge identified in the recent PalliPed study, emphasizing the heterogeneous distribution of specialized paediatric home services in Italy [ 11 ]. Our model serves as a scalable benchmark to bridge this gap, ensuring that high-level technological assistance remains patient-centred and accessible. The illustrative sample presented highlights the clinical versatility of the service; however, larger quantitative studies incorporating Patient-Reported Outcome Measures (PROMs) are needed to fully measure the socio-economic impact. Due to the complexity of cases at IGG, many patients lack a local General Practitioner (GP) capable of managing specialized needs. Consequently, the IGG HBHC model utilizes a multidisciplinary shared decision-making framework [ 12 ]. By acting as a liaison between the tertiary care centre and the home, the HBHC programme ensures a rapid, accessible, and patient-centred healthcare delivery system. Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the IRCCS Istituto Giannina Gaslini. Since this study describes a retrospective analysis of clinical practice and illustrative case reports, formal ethical approval for a clinical trial was not required according to national legislation. Consent for publication Written informed consent was obtained from the legal guardians of all minor patients for the publication of this study and any accompanying clinical data. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the Ministry of Health, Italy - Ricerca Corrente (Line: Paediatric Healthcare Models). Authors' contributions All authors (SD, MC, EC, VM) contributed equally to the conception, data collection, and drafting of the work. All authors read and approved the final version of the manuscript. Acknowledgements The authors thank the nursing staff of the Paediatric Home Care Service and the families for their cooperation. References Hallström I, Elander G. Families' needs when a child is long-term ill: a literature review with reference to nursing research. Int J Nurs Pract. 2007;13(3):193–200. 10.1111/j.1440-172X.2007.00624.x . Kai J. What worries parents when their preschool children are acutely ill, and why: a qualitative study. BMJ. 1996;313(7063):983–6. 10.1136/bmj.313.7063.983 . Wilson ME, Megel JE, Enenbach L, Carlson KL. The voices of children: stories about hospitalization. J Pediatr Health Care. 2010;24(2):95–102. 10.1016/j.pedhc.2009.02.007 . Parab CS, Cooper C, Woolfenden S, Piper SM. Specialist home-based nursing services for children with acute and chronic illnesses. Cochrane Database Syst Rev. 2013;6CD004383. 10.1002/14651858.CD004383.pub3 . Abid MH. Reducing unplanned readmissions in pediatric hospitals: applying patient and family-centered care. Glob J Qual Saf Healthc. 2023;6(4):99–100. 10.36401/GQSH-22-26 . Leyenaar JK, O'Brien ER, Leslie LK, et al. Families' priorities regarding hospital-to-home transitions for children with medical complexity. Pediatrics. 2017;139(1):e20161581. 10.1542/peds.2016-1581 . Benini F, Papadatou D, Lazzarin P, et al. Safety and feasibility of tracheostomy and gastrostomy home device replacements in pediatric patients: a 5-year retrospective study. Front Pediatr. 2025;13:1644830. 10.3389/fped.2025.1644830 . Guglielmetti C, Gilardi S, Marsilio M, et al. Navigating change for occupational wellbeing: Pediatricians' perspectives on tele-homecare integration in an Italian pediatric hospital. Front Psychol. 2024;15:1348270. 10.3389/fpsyg.2024.1348270 . Miano M, Manfredini L, Garaventa A, et al. Feasibility of a home care program in a pediatric hematology and oncology department. Results of the first year of activity at a single Institution. Haematologica. 2002;87(6):637–42. PMID: 12042034. Parker G, Spiers G, Gridley K, et al. Identifying boundaries and roles in intermediate care for children and young people: a rapid review. Child Care Health Dev. 2013;39(1):1–19. 10.1111/j.1365-2214.2012.01373.x . Benini F, Orzalesi M, Congedi S, et al. The specialized pediatric palliative care service in Italy: how is it working? Results of the nationwide PalliPed study. Ital J Pediatr. 2024;50(1):55. 10.1186/s13052-024-01621-1 . Pordes E, Gordon J, Sanders LM, Cohen E. Models of care delivery for children with medical complexity. Pediatrics. 2018;141(Suppl 3):S212–23. 10.1542/peds.2017-1284F . Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 29 Apr, 2026 Reviewers invited by journal 29 Apr, 2026 Editor assigned by journal 21 Feb, 2026 First submitted to journal 09 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8808940","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631691926,"identity":"3e0361f6-0716-4189-967a-24cad40ae025","order_by":0,"name":"Sandro Dallorso","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIie2QMUvDQBiGv+MgXaJdT5DkL1wIKKU1+SsNB3YppeONKcI53hpw8ackHDidZj3J4g/oIi4VHEzOgiBpiZvIPfDBO9zD+90H4HD8UQgAhtORzbN2cF4CHaB42ObrdtDvFGWVo8/D28eq4Xwaehg/vO54nUhZbdR6DcGlvO9VqF6xidaLSGCP3fm6YYXJclVQiM/NS78Cy4uzjVBIYD/GSDQMDMqVTyErSNm/mNxaJe0U9C6eWFhXxxUwXy1Zp8CJKBNaZntl3H8GarbxJNcL1v0F+5rNI2MVEhNy4GJyGT3nfHolRzcK7XiSBrVSb/7HLCDjA4v9JNtv01aQ+TAl/Y5DWxwOh+O/8wlCOFtdDUBrMgAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-2888-4122","institution":"Giannina GasliniPediatric Hospital: Istituto Giannina Gaslini","correspondingAuthor":true,"prefix":"","firstName":"Sandro","middleName":"","lastName":"Dallorso","suffix":""},{"id":631691927,"identity":"9574fd7a-9ca3-4ded-b1e3-15046e1f00dd","order_by":1,"name":"MC. 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The disruptive impact of illness is increased by the frequency and length of hospital admissions, as well as by crowded outpatient visits. It is well established that a child's mood and socialization are severely affected by prolonged clinical environments [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Paediatric Home Health Care (PHHC) is a vital, specialized system that delivers medical treatments, services, equipment, and supplies within a patient\u0026rsquo;s home and community. It aims to treat chronic conditions, disabilities, and acute illnesses while maintaining the family unit [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e The IRCCS Istituto Giannina Gaslini (IGG) is a tertiary care paediatric hospital providing comprehensive sub-specialty care located in Genoa, Liguria Region (northwest Italy). Approximately 60% of IGG patients originate from outside Liguria; this \"health migration\" occurs because patients seek high-quality care often unavailable near their homes. Since April 2000, a Hospital-Based Home Care (HBHC) programme has been operational for patients residing in the metropolitan Genoa area (approx. 250 km\u0026sup2;).\u003c/p\u003e"},{"header":"Service Organisation","content":"\u003cp\u003eStaff: The HBHC team consists of two senior paediatricians with extensive experience in onco-haematology, respiratory diseases, and palliative care, alongside four specialized paediatric nurses. The service operates seven days a week: 7:00 a.m. to 8:00 p.m. (Monday\u0026ndash;Friday) and 8:00 a.m. to 3:00 p.m. (Saturdays and holidays). Within these working hours and with a full staff, 8\u0026ndash;10 home visits per day can be guaranteed.\u003c/p\u003e \u003cp\u003eTake-in-charge Process: An in-hospital case manager contacts the HBHC team to define home care eligibility and develop a prospective plan for medically necessary care. Medical issues, non-medical needs, and the goals of both the patient and family are evaluated in depth. The official reference at the time of handover is represented by the discharge letter as well as the clinical diary present in the electronic medical record, both shared within the same software and accessible from any workstation. This is followed by an interview with the caregivers to explain service modalities and emphasize the strict cooperation between the HBHC and in-hospital teams, thereby reducing any parental feelings of abandonment. Prescriptions, therapy verification (e.g., chemotherapy, transfusions, supportive care), characteristics and description of the devices, and clinical diaries follow the same electronic pathways used within the hospital.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eIllustrative Clinical Cases\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eCase 1\u003c/strong\u003e \u003cp\u003eTechnology-Dependent Child (Respiratory)\u003c/p\u003e \u003c/p\u003e \u003cp\u003ePatient: 16-year-old boy. Diagnosis: Congenital hypomagnesemia requiring long-term tracheostomy and mechanical ventilation. Home Care Needs: 24-hour skilled care due to technology dependence. Nurses provide training and supervision to enable family autonomy in drug administration and device management. Scheduled bi-weekly medical evaluations focus on preventing respiratory infections and pressure ulcers. Outcome: Maintenance of stable respiratory function and safe G-tube feeding while minimizing Emergency Department visits.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCase 2\u003c/strong\u003e \u003cp\u003eMalignant Haematological Disease\u003c/p\u003e \u003c/p\u003e \u003cp\u003ePatient: 10-year-old boy. Diagnosis: Acute Lymphoblastic Leukaemia (ALL). Home Care Needs: During the consolidation phase, the patient received treatment via an ambulatory elastomeric pump to improve quality of life and reduce the risk of hospital-acquired infections. The family was trained to recognize \"red flags\". Outcome: Safe administration of medication and reduced hospital bed occupancy, allowing the patient to remain in a familiar environment.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCase 3\u003c/strong\u003e \u003cp\u003eSevere Congenital Haemostasis Management\u003c/p\u003e \u003c/p\u003e \u003cp\u003ePatient: 5-month-old girl. Diagnosis: Congenital severe Protein C deficiency with bilateral retinal thrombosis. Home Care Needs: Subcutaneous Protein C infusion via an off-label micro-infusion device (insulin pump) to maintain stable plasma levels. Outcome: Successful stabilization of Protein C levels, allowing the patient to attend a specialized rehabilitation centre.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCase 4\u003c/strong\u003e \u003cp\u003eCongenital Inflammatory Syndrome\u003c/p\u003e \u003c/p\u003e \u003cp\u003ePatient: 16-year-old girl. Diagnosis: SAVI Syndrome (STING-associated vasculopathy). Home Care Needs: Treatment of Invasive Pulmonary Aspergillosis (IPA) via thrice-weekly i.v. liposomal amphotericin-B. Management included Non-Invasive Ventilation (NIV) monitoring. Outcome: Stabilization of the infection and prevention of inflammatory flares, serving as a bridge to lung transplantation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe goals of PHHC are multifaceted: improving the child's quality of life, preventing unplanned readmissions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and supporting the family\u0026rsquo;s desire for normalcy during recovery [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Our experience with technology-dependent children aligns with recent Italian multicentre evidence suggesting that home-based management of complex devices, such as tracheostomies and gastrostomies, is not only feasible but safe when managed by specialized teams [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This hospital-centred approach mitigates the risks typically associated with home care. Furthermore, the integration of specialized nursing and medical oversight acts as a fundamental pillar for clinical efficacy, as highlighted by recent perspectives on Italian paediatric care coordination [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn additional significant advantage is the improved use of beds, especially out-patient beds. In our practice, hospital occupancy for specialties represented in these cases is always close to 100%, making home care indispensable. Financial advantages also emerge, increasing with the complexity of the cases treated, combined with a reduction in the use of hospital resources [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDespite the positive outcomes observed, the HBHC model is currently restricted to the metropolitan area of Genoa. This disparity in access reflects a broader national challenge identified in the recent PalliPed study, emphasizing the heterogeneous distribution of specialized paediatric home services in Italy [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Our model serves as a scalable benchmark to bridge this gap, ensuring that high-level technological assistance remains patient-centred and accessible.\u003c/p\u003e \u003cp\u003eThe illustrative sample presented highlights the clinical versatility of the service; however, larger quantitative studies incorporating Patient-Reported Outcome Measures (PROMs) are needed to fully measure the socio-economic impact. Due to the complexity of cases at IGG, many patients lack a local General Practitioner (GP) capable of managing specialized needs. Consequently, the IGG HBHC model utilizes a multidisciplinary shared decision-making framework [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. By acting as a liaison between the tertiary care centre and the home, the HBHC programme ensures a rapid, accessible, and patient-centred healthcare delivery system.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the IRCCS Istituto Giannina Gaslini. Since this study describes a retrospective analysis of clinical practice and illustrative case reports, formal ethical approval for a clinical trial was not required according to national legislation.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the legal guardians of all minor patients for the publication of this study and any accompanying clinical data.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Ministry of Health, Italy - Ricerca Corrente (Line: Paediatric Healthcare Models).\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eAll authors (SD, MC, EC, VM) contributed equally to the conception, data collection, and drafting of the work. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors thank the nursing staff of the Paediatric Home Care Service and the families for their cooperation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHallstr\u0026ouml;m I, Elander G. Families' needs when a child is long-term ill: a literature review with reference to nursing research. Int J Nurs Pract. 2007;13(3):193\u0026ndash;200. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1440-172X.2007.00624.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1440-172X.2007.00624.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKai J. What worries parents when their preschool children are acutely ill, and why: a qualitative study. BMJ. 1996;313(7063):983\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmj.313.7063.983\u003c/span\u003e\u003cspan address=\"10.1136/bmj.313.7063.983\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilson ME, Megel JE, Enenbach L, Carlson KL. The voices of children: stories about hospitalization. J Pediatr Health Care. 2010;24(2):95\u0026ndash;102. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.pedhc.2009.02.007\u003c/span\u003e\u003cspan address=\"10.1016/j.pedhc.2009.02.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParab CS, Cooper C, Woolfenden S, Piper SM. Specialist home-based nursing services for children with acute and chronic illnesses. 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Pediatrics. 2018;141(Suppl 3):S212\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/peds.2017-1284F\u003c/span\u003e\u003cspan address=\"10.1542/peds.2017-1284F\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"italian-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"itjp","sideBox":"Learn more about [Italian Journal of Pediatrics](http://ijponline.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ITJP/default.aspx","title":"Italian Journal of Pediatrics","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Paediatric Home Health Care, Medical Complexity, Multidisciplinary Team, Hospital-Based Care, Quality of Life, Healthcare Policy","lastPublishedDoi":"10.21203/rs.3.rs-8808940/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8808940/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eManaging paediatric medical complexity requires models that integrate hospital expertise with home care. We describe the 25-year experience of the IRCCS Giannina Gaslini (IGG) with its Hospital-Based Home Care (HBHC) programme.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe analysed the multidisciplinary HBHC model through four high-tech clinical cases: chronic respiratory failure, paediatric oncology, congenital haemostasis, and rare inflammatory syndromes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe model enabled the safe home management of mechanical ventilation and complex infusion therapies. Results highlight a reduction in hospital bed occupancy and improved family wellbeing, filling the gap in specialized local support.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003e The IGG HBHC service represents a scalable model that ensures continuity of care between hospital and home, optimizing resources and improving the quality of life for children with medical complexity.\u003c/p\u003e","manuscriptTitle":"Hospital-Based Paediatric Home Health Care: The Peculiar Experience of a Multidisciplinary Service in Italy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-07 11:37:44","doi":"10.21203/rs.3.rs-8808940/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2026-04-29T15:32:55+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-29T10:10:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-21T14:32:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"Italian Journal of Pediatrics","date":"2026-02-09T09:04:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"italian-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"itjp","sideBox":"Learn more about [Italian Journal of Pediatrics](http://ijponline.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ITJP/default.aspx","title":"Italian Journal of Pediatrics","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6f50a4da-14b4-4398-bf71-e6394e2773b3","owner":[],"postedDate":"May 7th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"","date":"2026-04-29T15:32:55+00:00","index":0,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T11:37:44+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-07 11:37:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8808940","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8808940","identity":"rs-8808940","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}