Rural-Urban Comparison of Post-PICU Home Nursing in Respiratory Technology-Dependent Children

Introduction: Some children with complex medical needs, including chronic respiratory technology needs (CRTN), may need to travel extended distances to receive specialized care. Little is known about the impact access to specialized care has on the families of children with CRTN. We aimed to describe the rural-urban differences in home care services following critical illness in children with CRTN, hypothesizing that rural residence would be associated with less home nursing availability.


Methods: Prospective, longitudinal cohort study of children < 17 years with CRTN hospitalized in the ICU. Families completed multimodal assessments at baseline, including PediHOME (validated measure of home care access and quality) and daily text messaging to assess missed nursing shifts. Distances were assessed from the family’s home to a children’s hospital using straight line distances. Rural/urban classification was based on 2024 U.S. Census Bureau data. Data are presented as n (%) and median [IQR].


Results: Of 44 participants, 17 (40%) lived in rural areas and 26 (60%) in urban areas. At baseline, 31 (70.5%) participants completed home nursing data (11 rural, 20 urban). Rural participants live farther from specialized pediatric care (116.9 miles [31.85-142.5] vs. 12.9 miles [7.9-18.1], p= 0.005) and live in areas with lower Child Opportunity Index (COI) 2.0 overall scores (2.2 vs. 1.8 p=0.041) and health subdomain scores (2.1 vs. 1.2, p=0.0038). Home nursing approval rate was similar between groups (64% rural vs. 65% urban). Participants had a similar number of approved (94 [10-109.5] vs. 82 [2.13-129.5], p=0.98) and received (55 [0 - 62.5] vs. 56 [0-70], p=0.89) hours of nursing care per week. In the first week following hospital discharge, 10.1% of rural families and 19.8% of urban families missed at least one nursing shift (p=1.0). No associations were found between distance and received hours (p=0.37) or overall COI and missed shifts (p=0.62).


Conclusions: Despite living farther from specialized care and in areas with lower COI scores, rural participants had similar home nursing approval, received hours, and missed shifts compared to urban participants. These findings suggest geographic and socioeconomic disparities may not impact home nursing access in this high-risk patient population.