Abstract
Neonatal intensive care unit (NICU) admissions have been increasing. Home visiting services are an integral part of caring for high-risk children with limited resources. The effectiveness of physician-led home visiting programs on post-NICU health outcomes is not well studied. The Pediatric Visiting Doctors (PVD) program provides home-based primary care for high-risk children including NICU graduates, for 6 months after discharge. The team consisted of a pediatrician, and care coordinator or social worker. The study compares the characteristics and care utilization of PVD program participants with a hospital-based pediatric clinic population. A retrospective cohort study of PVD infants born from 2013–2016, who were enrolled after referral during their NICU admission, was conducted. Data were also obtained on infants who were hospital clinic patients born during the same time frame, with parents residing in the PVD catchment area, and had a minimum 72-hour NICU stay. Between group differences were assessed; and logistic regression and generalized linear models were used to adjust for uneven group characteristics. Forty-six PVD participants completed the program, and 91 comparison infants had at least 6 months of post-NICU clinic visits. PVD program completers received a median of 5 home visits. There were no differences in emergency care use or hospitalization. PVD program participants were more likely to attend development clinic compared to the non-PVD group (59% vs 12%, p = 0.002). Physician-led home visiting services is a feasible way of providing clinical care to this population. Additional research is needed to assess patient-centered outcomes of these programs.
Highlights
The number of infants admitted to the neonatal intensive care unit (NICU) has been steadily increasing in all birth weight categories [1]
The purpose of this study is to examine the care utilization outcomes of a pilot, physician-led, home visiting program that serves high-risk NICU graduates
We adjusted for the following unbalanced patient characteristics: birthweight (BW), NICU length of stay, teen motherhood, ventilator requirement, and respiratory distress syndrome diagnosis (RDS)
Summary
The number of infants admitted to the neonatal intensive care unit (NICU) has been steadily increasing in all birth weight categories [1]. Previous literature has examined NICU cohort birth weight (BW) and gestational age (GA) outcomes and their impact on: hospitalization rates, development, and long-term cognitive function [5]. Home-visiting services have been an integral part of caring for high-risk children of low-resourced families, who often have difficulty accessing healthcare services. One study demonstrated a decrease in infant mortality among home visit participants [7]. Another study demonstrated improved childhood development for families who participate in programs with postpartum home visits [8]. There is little data on physician-led home visiting programs for NICU graduates within the first year of life. The purpose of this study is to examine the care utilization outcomes of a pilot, physician-led, home visiting program that serves high-risk NICU graduates
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