1
|
Feister J, Kan P, Lee HC, Sanders L. Readmission After Neonatal Intensive Care Unit Discharge: The Importance of Social Drivers of Health. J Pediatr 2024; 270:114014. [PMID: 38494087 DOI: 10.1016/j.jpeds.2024.114014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/23/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To determine associations between sociodemographic and medical factors and odds of readmission after discharge from the neonatal intensive care unit for infants with very low birth weight (<1500g). STUDY DESIGN Cohort study using linked data from the California Perinatal Quality Care Collaborative, California Vital Statistics, and the Child Opportunity Index (COI) 2.0. Infants with very low birth weight born from 2009 through 2018 in California were considered. Odds ratios of readmission within 30 days of discharge adjusting for infant medical factors, maternal sociodemographic factors, and birth hospital were calculated via multivariable logistic regression and fixed-effect logistic regression models. RESULTS A total of 42 411 infants met inclusion criteria. Also, 8.5% of all infants were readmitted within 30 days of discharge. In addition to traditional medical risk factors, two sociodemographic factors were significantly associated with increased odds of readmission in adjusted models: payor other than private insurance for delivery [aOR = 1.25 (95% CI 1.14-1.36)] and maternal education of less than high school degree [aOR = 1.19 (95% CI 1.06-1.33)]. Neighborhood Child Opportunity Index was not associated with odds of readmission. CONCLUSIONS Sociodemographic factors, including lack of private insurance and lower maternal educational attainment, are significantly and independently associated with increased odds of readmission after neonatal intensive care unit discharge, in addition to traditional medical risk factors. Socioeconomic deprivation and health literacy may contribute to risk of readmission. Targeted discharge interventions focused on addressing social drivers of health warrant exploration.
Collapse
Affiliation(s)
- John Feister
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Peiyi Kan
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Henry C Lee
- Department of Pediatrics, University of California San Diego, San Diego, CA
| | - Lee Sanders
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Department of Health Policy, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
2
|
McKelvey LM, Goudie A, Li J, Lewis KN. Examining Impacts of Healthy Families America on Infant Health Care. Acad Pediatr 2024; 24:570-578. [PMID: 37709196 DOI: 10.1016/j.acap.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Healthy Families America (HFA) is an evidence-based home visiting program that provides parenting education with the overall goal of preventing child maltreatment and optimizing child development. This study compares the health care utilization and vaccination of infants enrolled in HFA with similar infants not in the program. METHODS From January 2014 to December 2020, 604 children served statewide by HFA in Arkansas were identified in vital statistics and administrative medical claims records. Using propensity score matching, infants in HFA were matched with nonprogram control infants based on family demographics and birth characteristics. Double propensity-score adjustment method and generalized linear models were used to estimate program effects. RESULTS In the first year after birth hospital discharge and compared to a propensity score matched cohort of infants not enrolled, those enrolled in HFA had significantly greater use of the emergency department overall (incidence rate ratios (IRR) = 1.24 [95% confidence interval (CI) = 1.07-1.43], P = .004) and for less complex conditions (IRR = 1.22 [95% CI = 1.04-1.44], P = .01), more outpatient medical appointments for child wellness (IRR = 1.09 [95% CI = 1.03-1.15], P = .003), illness (IRR = 1.17 [95% CI = 1.07-1.29], P = .001), and speech and language therapies (IRR = 2.86 [95% CI = 1.18-6.93], P = .02), and more medical visits during which vaccinations were provided (IRR = 1.09 [95% CI = 1.04-1.15], P = .002). CONCLUSIONS Findings from the current study suggest that HFA supports increased health care utilization and visits in which vaccinations occurred during the first year of life.
Collapse
Affiliation(s)
- Lorraine M McKelvey
- Department of Family and Preventive Medicine (LM McKelvey and KN Lewis), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark.
| | - Anthony Goudie
- Department of Health Policy and Management (A Goudie), College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Jialiang Li
- Arkansas Center for Health Improvement (J Li), Little Rock, Ark
| | - Kanna N Lewis
- Department of Family and Preventive Medicine (LM McKelvey and KN Lewis), College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark
| |
Collapse
|
3
|
Toole C, DeGrazia M, Andrews TM, Bouve ME, Pezanowski R, Cole A, Kourembanas S, Hickey PA. No Place Like Home: Improving the Transition From NICU to Home Through the NICU to Nursery Program. Adv Neonatal Care 2024; 24:46-57. [PMID: 38215025 DOI: 10.1097/anc.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
BACKGROUND Boston Children's Hospital's Level IV Neonatal Intensive Care Unit (NICU) discharges about a third of its medically complex infants home. Parental feedback indicated a need for more education and training in discharge preparation. PURPOSE The NICU to Nursery (N2N) program was created to better prepare parents to care for their medically complex infants following Level IV NICU discharge. The goals were to (1) mitigate safety risks, (2) assess parent satisfaction, (3) assess pediatric primary care providers' (PCPs') satisfaction, (4) assess community visiting nurses' and PCPs' knowledge deficits, and (5) develop educational materials. METHODS The N2N program provided parents with pre- and postdischarge assessments with an experienced nurse. Parents completed a survey following assessments to measure satisfaction. To enhance PCPs' knowledge, they were sent summary reports and asked for feedback. PCP feedback, along with a needs assessment of community visiting nurses, guided the development of free Web-based educational videos. RESULTS One hundred and fifty-five parents participated in the N2N program. Parents' educational needs included medication education, safe sleep, and well-infant care, with some requiring significant nursing interventions for safety risk mitigation. Most PCPs found the home visit reports helpful. Knowledge deficits identified among PCPs and community visiting nurses included management of tubes and drains, growth and nutrition, and emergency response. More than 100,000 providers viewed the 3 Web-based educational videos developed. IMPLICATIONS FOR PRACTICE AND RESEARCH The N2N program fills a crucial gap in the transition of medically complex infants discharged home. The next steps are developing best practices for virtual in-home assessments.
Collapse
Affiliation(s)
- Cheryl Toole
- Neonatal Intensive Care Unit, Boston Children's Hospital, Massachusetts (Mss Toole, Andrews, Bouve, and Pezanowski and Drs DeGrazia and Kourembanas); Harvard Medical School, Boston, Massachusetts (Drs DeGrazia, Kourembanas, and Hickey); and Department of Nursing and Patient Care Operations, Boston Children's Hospital, Massachusetts (Ms Cole and Dr Hickey)
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Griffith T, Singh A, Naber M, Hummel P, Bartholomew C, Amin S, White-Traut R, Garfield L. Scoping review of interventions to support families with preterm infants post-NICU discharge. J Pediatr Nurs 2022; 67:e135-e149. [PMID: 36041959 PMCID: PMC9729411 DOI: 10.1016/j.pedn.2022.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND A successful transition from the NICU to home is fundamental for the long-term health and well-being of preterm infants. Post-NICU discharge, parents may experience a lack of support and resources during the transition to home. The purpose of this scoping review was to identify post-NICU discharge interventions that may reduce parental stress and provide support to families with preterm infants. METHOD Systematic searches of databases, i.e., PubMed, Web of Science, and CINAHL. Inclusion criteria were data-based articles: 1) published in English between 2011 and 2021, 2) published in peer-reviewed journals, (3) focused on families with preterm infants, and (4) focused on interventions to reduce parental stress and provide support to families with preterm infants post-NICU discharge. RESULTS 26 articles were included and synthesized. We identified the following face-to-face and remote communication interventions: in-person home visits, phone/video calls, text messages, periodic email questionnaires, mobile/website apps, and online social networking sites. DISCUSSION Families may highly benefit from a comprehensive family-focused post-NICU discharge follow-up intervention that includes face-to-face and remote communication and support. Post-NICU discharge interventions are imperative to provide education related to infant care and health, increase parental confidence and competency, increase parent-infant relationship, promote emotional and social support, reduce unplanned hospital visits, parental stress, and maternal post-partum depression.
Collapse
Affiliation(s)
- Thao Griffith
- Department of Family and Community Health Nursing, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA.
| | - Anamika Singh
- Department of Family and Community Health Nursing, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| | - Margaret Naber
- Division of Neonatology, Loyola University Medical Center, Maywood, IL, USA
| | - Patricia Hummel
- Division of Neonatology, Loyola University Medical Center, Maywood, IL, USA
| | | | - Sachin Amin
- Division of Neonatology, Loyola University Medical Center, Maywood, IL, USA
| | - Rosemary White-Traut
- Nursing Research, Children's Wisconsin, Milwaukee, WI, United States of America; Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Lindsey Garfield
- Department of Family and Community Health Nursing, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| |
Collapse
|
5
|
Adams WA, Malcolm W, Goldstein R, Lemmon ME, Mago-Shah D, Cotten M, Peterson J, Fisher K, Younge N. Longitudinal medical needs for periviable NICU survivors. Early Hum Dev 2022; 169:105580. [PMID: 35569179 PMCID: PMC9627457 DOI: 10.1016/j.earlhumdev.2022.105580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the technologies required, medications needed, and early intervention services utilized from discharge to 12 months post-discharge for periviable infants (22 0/7 to 24 6/7 weeks gestational age) followed in a comprehensive NICU follow-up clinic. STUDY DESIGN Information regarding medication use, technology requirement, and early intervention services was collected prospectively at one, six, and twelve months after discharge. Neurodevelopmental assessment was completed at 12 months corrected age. RESULT 69 periviable infants were actively treated and survived to discharge during the study period. 54 infants were enrolled and followed in the comprehensive NICU follow-up clinic. Use of technology and prescribed medications decreased with a 46% reduction of infants requiring ≥1 technology device (74.1% vs. 40.4%, p < 0.01) and 64% reduction in infants requiring ≥1 medication (88.9% vs 31.9%, p < 0.01) 12 months post discharge. There was an increase in early intervention services with 83% of infants receiving services by 12 months post discharge. CONCLUSION Technology and medication requirements were high at discharge but notably decreased in the first year after discharge concurrent with increased enrollment in early interventional services. Many periviable infants survive without severe short-term developmental delays.
Collapse
Affiliation(s)
- W. Aaron Adams
- Duke University School of Medicine, Department of Pediatrics, Division of Neonatology, 2400 Pratt Street, 8 Floor, Durham, NC 27705, United States of America,Corresponding author. (W.A. Adams)
| | - William Malcolm
- Duke University School of Medicine, Department of Pediatrics, Division of Neonatology, 2400 Pratt Street, 8 Floor, Durham, NC 27705, United States of America
| | - Ricki Goldstein
- University of Kentucky, School of Medicine, Department of Pediatrics, Division of Neonatology, 1000 South Limestone, Lexington, KY 40536, United States of America
| | - Monica E. Lemmon
- Duke University School of Medicine, Department of Pediatrics, Division of Neurology and Neurodevelopmental Medicine, Department of Population Health Sciences, T0913 Children's Health Center, DUMC Box 3936, Durham, NC 27710, United States of America
| | - Deesha Mago-Shah
- Duke University School of Medicine, Department of Pediatrics, Division of Neonatology, 2400 Pratt Street, 8 Floor, Durham, NC 27705, United States of America
| | - Michael Cotten
- Duke University School of Medicine, Department of Pediatrics, Division of Neonatology, 2400 Pratt Street, 8 Floor, Durham, NC 27705, United States of America
| | - Jennifer Peterson
- Duke University School of Medicine, Department of Pediatrics, Division of Neonatology, 2400 Pratt Street, 8 Floor, Durham, NC 27705, United States of America
| | - Kimberley Fisher
- Duke University School of Medicine, Department of Pediatrics, Division of Neonatology, 2400 Pratt Street, 8 Floor, Durham, NC 27705, United States of America
| | - Noelle Younge
- Duke University School of Medicine, Department of Pediatrics, Division of Neonatology, 2400 Pratt Street, 8 Floor, Durham, NC 27705, United States of America
| |
Collapse
|
6
|
David O. Improving the Life Chances of NICU Graduates. Pediatrics 2021; 148:peds.2020-049747. [PMID: 34083359 DOI: 10.1542/peds.2020-049747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Olds David
- Prevention Research Center for Family and Child Health, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| |
Collapse
|