2026-04-17T03:59:58Zhttps://recercat.cat/oai/request

oai:recercat.cat:2117/4246342025-07-23T03:52:09Zcom_2072_1033col_2072_452951

Identification of risk factors for hospital readmission in paediatric patients with cancer enrolled in a home hospitalisation programme Colomar Riutort, Maria Antònia Universitat de Barcelona Pérez Jaume, Sara Àrees temàtiques de la UPC::Matemàtiques i estadística Cancer in children — Treatment Hospitals -- Home care programs Multivariate analysis Pediatric cancer home-based hospitalization generalized estimating equations generalized linear mixed effects models Càncer infantil — Tractament Hospitalització domiciliària Anàlisi multivariable Classificació AMS::62 Statistics::62P Applications Classificació AMS::62 Statistics::62J Linear inference, regression Classificació AMS::62 Statistics::62G Nonparametric inference Pediatric cancer is a rare and life-threatening disease that requires long and complex treatments, often involving repeated hospitalizations. To address the challenges of frequent hospital stays, the Pediatric Cancer Center Barcelona (PCCB), part of Sant Joan de Déu Hospital (SJD), started a home hospitalization program aimed at improving the quality of life for these patients. Home hospitalization offers significant benefits. However, complications during home care can result in hospital readmissions, an undesirable outcome. This study used data from the PCCB home hospitalization program, spanning from its inception in late 2021 to June 2024, with two aims. The first aim is to describe the characteristics of patients admitted to the program, and the second aim is to identify risk factors for hospital readmission. Since many patients in this study underwent several home-based hospitalizations, traditional statistical methods assuming independence between observations were unsuitable. Instead, we applied advanced statistical approaches for repeated measures: Generalized Estimating Equations (GEE) and Generalized Linear Mixed Models (GLMM). Variable selection was guided by an adapted Hosmer-Lemeshow algorithm, emphasizing clinical interpretability over automated methods. We identified two risk factors for hospital readmission: decreased neutrophil counts and the occurrence of intravenous route incidences during the home-based hospitalization; and a protective factor was also identified among the reasons for the home-based hospitalization. These results align with clinical expectations and provide actionable insights for clinicians managing home-based care. With these findings, oncologists can better assess the risk of readmission and make more informed decisions, ultimately improving outcomes for pediatric cancer patients in home-based hospitalization programs. 2025-01-24 Master thesis https://hdl.handle.net/2117/424634 PRISMA-191878 eng Restricted access - confidentiality agreement application/pdf Universitat Politècnica de Catalunya