1
|
Neel ML, Bora S, Brachio SS, Duncan A, Vanderbilt D, Benninger K, Kendrick-Allwood S, Maitre NL. Challenges and Opportunities in High-Risk Infant Follow-Up: Progress from the 2022 Networking Session at the Pediatric Academic Societies. J Pediatr 2024; 270:113971. [PMID: 38479638 DOI: 10.1016/j.jpeds.2024.113971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Mary Lauren Neel
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
| | - Samudragupta Bora
- Department of Pediatrics, Case Western Reserve University School of Medicine and University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Sandhya S Brachio
- Department of Pediatrics, Columbia University & New York-Presbyterian Hospital, New York, NY
| | - Andrea Duncan
- Department of Pediatrics, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA
| | - Douglas Vanderbilt
- Department of Pediatrics, Keck School of Medicine at University of Southern California and Children's Hospital Los Angeles, Los Angeles, CA
| | - Kristen Benninger
- Department of Pediatrics, The Ohio State University School of Medicine and Nationwide Children's Hospital, Columbus, OH
| | - Salathiel Kendrick-Allwood
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA
| | - Nathalie L Maitre
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA
| |
Collapse
|
2
|
Montoya-Williams D, Gualy S, Mazur M, Huber M, Peña MM, DeMauro SB, Duncan AF. Impact of COVID-19 on Infants followed after Discharge from the Neonatal Intensive Care Unit Using a Telemedicine Model. Am J Perinatol 2024; 41:e1075-e1083. [PMID: 36452972 PMCID: PMC10349908 DOI: 10.1055/a-1990-8571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) continues to have a profound impact on infant health care and health outcomes. In this study, we aimed to characterize the social impact of the first COVID-19 lockdown on families in a neonatal follow-up program (NFP). Given the ongoing increased use of telehealth across the medicine, we also evaluated for patient-level differences in virtual visit rates to identify patients at risk of follow-up challenges. STUDY DESIGN To assess the impact of virtual health care utilization, we conducted a retrospective cohort study to describe challenges associated with telemedicine use in this vulnerable patient population during our telemedicine epoch (March 13, 2020-July 31, 2020). We also looked for patient-level factors associated with attending NFP visits as scheduled. Finally, we summarized caregiver responses to a COVID-19 Obstacles Assessment Survey and assessed for racial disparities in these responses. RESULTS When comparing patients who completed their virtual visit to those who did not, we found no differences by infants' sex, birth weight, gestational age at birth, or caregiver self-reported race and ethnicity. However, infants whose visits did not occur were more often discharged with equipment or covered by public insurance. Nine percent of families reported food insecurity. CONCLUSION During the initial COVID-19 lockdown, families with infants discharged from a neonatal intensive care unit (NICU) faced significant obstacles caring for their infants and attending scheduled follow-up visits. Infants in families with lower socioeconomic status or with increased medical complexity faced increased challenges in attending virtual follow-up visits during this epoch. Given the ongoing reliance on telemedicine in health care and the need to better prepare for future epidemics/pandemics, this study offers critical information that can assist neonatal teams in bolstering transitions to home and creating stronger safety nets for their patients after discharge. KEY POINTS · Telemedicine works well for high-risk neonatal populations.. · Infant medical complexity may be a risk factor for challenges attending neonatal follow-up visits.. · NICUs should work to prevent food insecurity postdischarge..
Collapse
Affiliation(s)
- Diana Montoya-Williams
- Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
| | | | | | | | | | - Sara B. DeMauro
- Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
| | - Andrea F. Duncan
- Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
| |
Collapse
|
3
|
Litt JS, Halfon N, Msall ME, Russ SA, Hintz SR. Ensuring Optimal Outcomes for Preterm Infants after NICU Discharge: A Life Course Health Development Approach to High-Risk Infant Follow-Up. CHILDREN (BASEL, SWITZERLAND) 2024; 11:146. [PMID: 38397258 PMCID: PMC10886801 DOI: 10.3390/children11020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024]
Abstract
Children born prematurely (<37 weeks' gestation) have an increased risk for chronic health problems and developmental challenges compared to their term-born peers. The threats to health and development posed by prematurity, the unintended effects of life-sustaining neonatal intensive care, the associated neonatal morbidities, and the profound stressors to families affect well-being during infancy, childhood, adolescence, and beyond. Specialized clinical programs provide medical and developmental follow-up care for preterm infants after hospital discharge. High-risk infant follow-up, like most post-discharge health services, has many shortcomings, including unclear goals, inadequate support for infants, parents, and families, fragmented service provisions, poor coordination among providers, and an artificially foreshortened time horizon. There are well-documented inequities in care access and delivery. We propose applying a life course health development framework to clinical follow-up for children born prematurely that is contextually appropriate, developmentally responsive, and equitably deployed. The concepts of health development, unfolding, complexity, timing, plasticity, thriving, and harmony can be mapped to key components of follow-up care delivery to address pressing health challenges. This new approach envisions a more effective version of clinical follow-up to support the best possible functional outcomes and the opportunity for every premature infant to thrive within their family and community environments over their life course.
Collapse
Affiliation(s)
- Jonathan S. Litt
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Department of Social and Behavioral Pediatrics, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Neal Halfon
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, CA 90024, USA; (N.H.); (S.A.R.)
- Department of Pediatrics, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA 90024, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
- Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA 90095, USA
| | - Michael E. Msall
- Department of Pediatrics, Sections of Developmental and Behavioral Pediatrics and Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago Medicine, Chicago, IL 60637, USA;
| | - Shirley Ann Russ
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, CA 90024, USA; (N.H.); (S.A.R.)
- Department of Pediatrics, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA 90024, USA
| | - Susan R. Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94305, USA;
| |
Collapse
|
4
|
Rosenfeld LE, McCullagh K, King CJ, Torres M, Litt JS. Organizational Health Literacy as a Tool for Health Equity: Application in a High-Risk Infant Follow-Up Program. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1658. [PMID: 37892321 PMCID: PMC10605611 DOI: 10.3390/children10101658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Healthy People 2030 emphasizes personal health literacy (individual skills) and organizational health literacy-the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. However, research on the latter is in the early stages. METHODS This study describes an organizational health literacy assessment in a U.S. urban academic children's hospital. A variety of evidence-based health literacy assessments were used to assess patient information materials and the environment, including institutional practices, navigation, culture and language, and communication. Trained interviewers and analysts reached consensus for all assessments. RESULTS Information Items: SMOG scores (n = 9) ranged from 7th- to 14th-grade reading level (average = 11.3). PEMAT-P scores (n = 9) ranged from 43.8% to 93.8% understandability and 0% to 80% actionability. CDC CCI scores (literacy demand) (n = 6) ranged from 18.2% to 58.8% (≥90% = excellent). SAM scores (suitability) (n = 6) fell in the "adequate" range (43.2-58.3%). The PMOSE/IKIRSCH scores (complexity) (n = 3) noted low-moderate difficulty. Apter's Hierarchy (n = 4) revealed three numeracy domains (50% = descriptive purposes and decision-making, 100% = interpreting information). Organization-level: Walking interviews highlighted organizational facilitators and barriers related to the pre-visit and visit environments. HLE2 domain scores ranged from 52% to 68%. CONCLUSIONS Organizational health literacy demands far outweigh the average literacy skills of adults in the U.S. (patients and staff). Findings can be used to hone quality improvement and other processes to focus on structural solutions to increase health equity.
Collapse
Affiliation(s)
- Lindsay E. Rosenfeld
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Boston Children’s Hospital, Boston, MA 02115, USA; (K.M.); (C.J.K.)
- Heller School for Social Policy & Management, Brandeis University, Waltham, MA 02453, USA
| | - Kelly McCullagh
- Boston Children’s Hospital, Boston, MA 02115, USA; (K.M.); (C.J.K.)
| | - Carolyn J. King
- Boston Children’s Hospital, Boston, MA 02115, USA; (K.M.); (C.J.K.)
| | - Micaela Torres
- Charles R. Drew, UCLA Medical Education Program, Los Angeles, CA 90059, USA;
- UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Jonathan S. Litt
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Boston Children’s Hospital, Boston, MA 02115, USA; (K.M.); (C.J.K.)
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| |
Collapse
|
5
|
Liebowitz M, Kramer KP, Rogers EE. All Care is Brain Care: Neuro-Focused Quality Improvement in the Neonatal Intensive Care Unit. Clin Perinatol 2023; 50:399-420. [PMID: 37201988 DOI: 10.1016/j.clp.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Neonates requiring intensive care are in a critical period of brain development that coincides with the neonatal intensive care unit (NICU) hospitalization, placing these infants at high risk of brain injury and long-term neurodevelopmental impairment. Care in the NICU has the potential to be both harmful and protective to the developing brain. Neuro-focused quality improvement efforts address 3 main pillars of neuroprotective care: prevention of acquired injury, protection of normal maturation, and promotion of a positive environment. Despite challenges in measurement, many centers have shown success with consistent implementation of best and potentially better practices that may improve markers of brain health and neurodevelopment.
Collapse
Affiliation(s)
- Melissa Liebowitz
- Envision Physician Services, St. Francis Hospital, 6001 East Woodmen Road, Colorado Springs, CO 80923, USA
| | - Katelin P Kramer
- Department of Pediatrics, University of California, 550 16th Avenue, 5th Floor, San Francisco, CA 94143, USA; University of California, Benioff Children's Hospital, 550 16th Avenue, 5th Floor, San Francisco, CA 94143, USA.
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California, 550 16th Avenue, 5th Floor, San Francisco, CA 94143, USA; University of California, Benioff Children's Hospital, 550 16th Avenue, 5th Floor, San Francisco, CA 94143, USA. https://twitter.com/eerogersmd
| |
Collapse
|
6
|
Hintz SR, deRegnier RA, Vohr BR. Outcomes of Preterm Infants: Shifting Focus, Extending the View. Clin Perinatol 2023; 50:1-16. [PMID: 36868700 DOI: 10.1016/j.clp.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Advances in perinatal care have led to remarkable long-term survival for infants who are born preterm. This article reviews the broader context of follow-up care, highlighting the need to reenvision some areas, such as improving parental support by embedding parental involvement in the neonatal intensive care unit, incorporating parental perspectives about outcomes into follow-up care models and research, supporting their mental health, addressing social determinants of health and disparities, and advocating for change. Multicenter quality improvement networks allow identification and implementation of best practices for follow-up care.
Collapse
Affiliation(s)
- Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Road, 4th Floor, Palo Alto, CA 94304, USA.
| | - Raye-Ann deRegnier
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 45, Chicago, IL 60611, USA
| | - Betty R Vohr
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905, USA
| |
Collapse
|
7
|
Abstract
Long-standing health disparities in maternal reproductive health, infant morbidity and mortality, and long-term developmental outcomes are rooted in a foundation of structural racism. Social determinants of health profoundly affect reproductive health outcomes of Black and Hispanic women disproportionately; they have higher rates of death during pregnancy and preterm birth. Their infants are also more likely to be cared for in poorer quality neonatal intensive care units (NICUs), receive poorer quality of NICU care, and are less likely to be referred to an appropriate high-risk NICU follow-up program. Interventions that mitigate the impact of racism will help to eliminate health disparities.
Collapse
Affiliation(s)
- Yvette R Johnson
- Texas Christian University, Burnett School of Medicine, Cook Children's Medical Center, N.E.S.T. Developmental Follow-up Clinic, 1500 Cooper Street, Fort Worth, TX 76104, USA.
| | - Charleta Guillory
- Baylor College of Medicine, Texas Children's Hospital, Section of Neonatology, 6621 Fannin, Houston, TX 77030, USA
| | - Sonia Imaizumi
- Newtown Square, MultiPlan.com, 18 Campus Boulevard, Suite 200, Newtown Square, PA 19073, USA
| |
Collapse
|
8
|
Haffner DN, Bauer Huang SL. Using Telemedicine to Overcome Barriers to Neurodevelopmental Care from the Neonatal Intensive Care Unit to School Entry. Clin Perinatol 2023; 50:253-268. [PMID: 36868709 DOI: 10.1016/j.clp.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Dedicated Neonatal Intensive Care Unit (NICU) follow-up programs are recommended for ongoing surveillance for infants at high-risk for future neurodevelopmental impairment (NDI). Systemic, socioeconomic, and psychosocial barriers remain for referrals and the continued neurodevelopmental follow-up of high-risk infants. Telemedicine can help overcome these barriers. Telemedicine allows standardization of evaluations, increased referral rates, and reduced time to follow-up as well as increased therapy engagement. Telemedicine can expand neurodevelopmental surveillance and support all NICU graduates, facilitating the early identification of NDI. However, with the recent expansion of telemedicine during the COVID-19 pandemic, new barriers related to access and technological support have arisen.
Collapse
Affiliation(s)
- Darrah N Haffner
- Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University, 700 Children's Dr, Columbus, OH 43205, USA.
| | - Sarah L Bauer Huang
- Department of Pediatric and Developmental Neurology, Department of Neurology, Washington University in Saint Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA
| |
Collapse
|
9
|
Fraiman YS, Edwards EM, Horbar JD, Mercier CE, Soll RF, Litt JS. Racial Inequity in High-Risk Infant Follow-Up Among Extremely Low Birth Weight Infants. Pediatrics 2023; 151:e2022057865. [PMID: 36594226 PMCID: PMC10696436 DOI: 10.1542/peds.2022-057865] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES High-risk infant follow-up programs (HRIFs) are a recommended standard of care for all extremely low birth weight (ELBW) infants to help mitigate known risks to long-term health and development. However, participation is variable, with known racial and ethnic inequities, though hospital-level drivers of inequity remain unknown. We conducted a study using a large, multicenter cohort of ELBW infants to explore within- and between-hospital inequities in HRIF participation. METHODS Vermont Oxford Network collected data on 19 503 ELBW infants born between 2006 and 2017 at 58 US hospitals participating in the ELBW Follow-up Project. Primary outcome was evaluation in HRIF at 18 to 24 months' corrected age. The primary predictor was infant race and ethnicity, defined as maternal race (non-Hispanic white, non-Hispanic Black, Hispanic, Asian American, Native American, other). We used generalized linear mixed models to test within- and between-hospital variation and inequities in HRIF participation. RESULTS Among the 19 503 infants, 44.7% (interquartile range 31.1-63.3) were seen in HRIF. Twenty six percent of the total variation in HRIF participation rates was due to between-hospital variation. In adjusted models, Black infants had significantly lower odds of HRIF participation compared with white infants (adjusted odds ratio, 0.73; 95% confidence interval, 0.64-0.83). The within-hospital effect of race varied significantly between hospitals. CONCLUSIONS There are significant racial inequities in HRIF participation, with notable variation within and between hospitals. Further study is needed to identify potential hospital-level targets for interventions to reduce this inequity.
Collapse
Affiliation(s)
- Yarden S. Fraiman
- Department of Neonatology, Beth Israel Deaconess Medical Center and Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Erika M. Edwards
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, The Robert Larner, MD, College of Medicine, The University of Vermont and the University of Vermont Children’s Hospital, Burlington, Vermont
- Department of Mathematics and Statistics, College of Engineering and Mathematical Studies, The University of Vermont, Burlington, Vermont
| | - Jeffrey D. Horbar
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, The Robert Larner, MD, College of Medicine, The University of Vermont and the University of Vermont Children’s Hospital, Burlington, Vermont
| | - Charles E. Mercier
- Department of Pediatrics, The Robert Larner, MD, College of Medicine, The University of Vermont and the University of Vermont Children’s Hospital, Burlington, Vermont
| | - Roger F. Soll
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, The Robert Larner, MD, College of Medicine, The University of Vermont and the University of Vermont Children’s Hospital, Burlington, Vermont
| | - Jonathan S. Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center and Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
10
|
Lakshmanan A, Rogers EE, Lu T, Gray E, Vernon L, Briscoe H, Profit J, Jocson MAL, Hintz SR. Disparities and Early Engagement Associated with the 18- to 36-Month High-Risk Infant Follow-Up Visit among Very Low Birthweight Infants in California. J Pediatr 2022; 248:30-38.e3. [PMID: 35597303 DOI: 10.1016/j.jpeds.2022.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/14/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine follow-up rates for the high-risk infant follow-up (HRIF) visit at 18-36 months among infants with very low birthweights and identify factors associated with completion. STUDY DESIGN We completed a retrospective cohort study using linked California Perinatal Quality of Care Collaborative neonatal intensive care unit, California Perinatal Quality of Care Collaborative California Children's Services HRIF, and Vital Statistics Birth Cohort databases. We identified maternal, sociodemographic, neonatal, clinical, and HRIF program level factors associated with the 18- to 36-month follow-up using multivariable Poisson regression. RESULTS From 2010 to 2015, among 19 284 infants with very low birthweight expected to attend at least 1 visit at 18-36 months, 10 249 (53%) attended. On multivariable analysis, factors independently associated with attendance at an 18- to 36-month visit included estimated gestational age (relative risk [RR], 1.21; 95% CI, 1.15-1.26; <26 weeks vs ≥31 weeks), maternal education (RR, 1.09; 95% CI, 1.06-1.12; college degree or more vs high school), distance from clinic (RR, 0.92; 95% CI, 0.89-0.97; fourth quartile vs first quartile), and Black non-Hispanic race vs White race (RR, 0.88; 95% CI, 0.84-0.92). However, completion of an initial HRIF visit within the first 12 months was the factor most strongly associated with completion of an 18- to 36-month visit (RR, 6.47; 95% CI, 5.91-7.08). CONCLUSIONS In a California very low birthweight cohort, maternal education, race, and distance from the clinic were associated with sustained HRIF participation, but attendance at a visit by 12 months was the most significantly associated factor. These findings highlight the importance of early engagement with all families to ensure equitable follow-through for children born preterm.
Collapse
Affiliation(s)
- Ashwini Lakshmanan
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA.
| | | | - Tianyao Lu
- California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Erika Gray
- California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Lelis Vernon
- Florida Perinatal Quality Collaborative (PQC), Tampa, FL; Stanford University School of Medicine Department of Pediatrics, Division of Neonatal and Developmental Medicine, Palo Alto, CA
| | | | - Jochen Profit
- California Perinatal Quality Care Collaborative, Palo Alto, CA; Florida Perinatal Quality Collaborative (PQC), Tampa, FL
| | - Maria A L Jocson
- California Department of Health Care Services, California Children's Services, Sacramento, CA
| | - Susan R Hintz
- California Perinatal Quality Care Collaborative, Palo Alto, CA; Florida Perinatal Quality Collaborative (PQC), Tampa, FL
| |
Collapse
|
11
|
Williams CN, Hall TA, Francoeur C, Kurz J, Rasmussen L, Hartman ME, O'meara AI, Ferguson NM, Fink EL, Walker T, Drury K, Carpenter JL, Erklauer J, Press C, Wainwright MS, Lovett M, Dapul H, Murphy S, Risen S, Guerriero RM, Woodruff A, Guilliams KP. Continuing Care For Critically Ill Children Beyond Hospital Discharge: Current State of Follow-up. Hosp Pediatr 2022; 12:359-393. [PMID: 35314865 PMCID: PMC9182716 DOI: 10.1542/hpeds.2021-006464] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Survivors of the PICU face long-term morbidities across health domains. In this study, we detail active PICU follow-up programs (PFUPs) and identify perceptions and barriers about development and maintenance of PFUPs. METHODS A web link to an adaptive survey was distributed through organizational listservs. Descriptive statistics characterized the sample and details of existing PFUPs. Likert responses regarding benefits and barriers were summarized. RESULTS One hundred eleven respondents represented 60 institutions located in the United States (n = 55), Canada (n = 3), Australia (n = 1), and the United Kingdom (n = 1). Details for 17 active programs were provided. Five programs included broad PICU populations, while the majority were neurocritical care (53%) focused. Despite strong agreement on the need to assess and treat morbidity across multiple health domains, 29% were physician only programs, and considerable variation existed in services provided by programs across settings. More than 80% of all respondents agreed PFUPs provide direct benefits and are essential to advancing knowledge on long-term PICU outcomes. Respondents identified "lack of support" as the most important barrier, particularly funding for providers and staff, and lack of clinical space, though successful programs overcome this challenge using a variety of funding resources. CONCLUSIONS Few systematic multidisciplinary PFUPs exist despite strong agreement about importance of this care and direct benefit to patients and families. We recommend stakeholders use our description of successful programs as a framework to develop multidisciplinary models to elevate continuity across inpatient and outpatient settings, improve patient care, and foster collaboration to advance knowledge.
Collapse
Affiliation(s)
- Cydni N Williams
- Divisions of Pediatric Critical Care.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
| | - Trevor A Hall
- Pediatric Psychology.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
| | - Conall Francoeur
- Department of Pediatrics, CHU de Québec - Université Laval Research Center, Quebec, QC, Canada
| | - Jonathan Kurz
- Translational Pharmacology, Merck & Co., Inc., North Wales, Pennsylvania
| | - Lindsey Rasmussen
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Mary E Hartman
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Am Iqbal O'meara
- Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Nikki Miller Ferguson
- Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Ericka L Fink
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tracie Walker
- Division of Pediatric Critical Care, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | | | - Jessica L Carpenter
- Division of Pediatric Neurology, Departments of Pediatrics and Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jennifer Erklauer
- Sections of Critical Care Medicine and Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Craig Press
- Section of Child Neurology, Department of Pediatrics, University of Colorado, Boulder, Colorado
| | - Mark S Wainwright
- Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, Washington
| | - Marlina Lovett
- Division of Critical Care Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Heda Dapul
- Division of Pediatric Critical Care, Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
| | - Sarah Murphy
- Division of Pediatric Critical Care, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Sarah Risen
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Rejean M Guerriero
- Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Alan Woodruff
- Section of Pediatric Critical Care, Department of Anesthesiology.,Critical Illness, Injury and Recovery Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristin P Guilliams
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.,Section of Pediatric Critical Care, Department of Anesthesiology.,Washington University School of Medicine, Mallinckrodt Institute of Radiology, Division of Neuroradiology, St. Louis, Missouri
| |
Collapse
|
12
|
Race, language, and neighborhood predict high-risk preterm Infant Follow Up Program participation. J Perinatol 2022; 42:217-222. [PMID: 34404926 PMCID: PMC8859815 DOI: 10.1038/s41372-021-01188-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/22/2021] [Accepted: 08/06/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Infant Follow Up Programs (IFUPs) provide developmental surveillance for preterm infants after hospital discharge but participation is variable. We hypothesized that infants born to Black mothers, non-English speaking mothers, and mothers who live in "Very Low" Child Opportunity Index (COI) neighborhoods would have decreased odds of IFUP participation. STUDY DESIGN There were 477 infants eligible for IFUP between 1/1/2015 and 6/6/2017 from a single large academic Level III NICU. Primary outcome was at least one visit to IFUP. We used multivariable logistic regression to identify factors associated with IFUP participation. RESULT Two hundred infants (41.9%) participated in IFUP. Odds of participation was lower for Black compared to white race (aOR 0.43, p = 0.03), "Very Low" COI compared to "Very High" (aOR 0.39, p = 0.02) and primary non-English speaking (aOR 0.29, p = 0.01). CONCLUSION We identified disparities in IFUP participation. Further study is needed to understand underlying mechanisms to develop targeted interventions for reducing inequities.
Collapse
|
13
|
Early developmental screening and intervention for high-risk neonates - From research to clinical benefits. Semin Fetal Neonatal Med 2021; 26:101203. [PMID: 33547000 DOI: 10.1016/j.siny.2021.101203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
With advances in neonatal care there has been an increase in survival rates for infants born very preterm and/or with complex needs, such as those who require major surgery, who may not have survived decades ago. Despite advances in survival, these infants remain at high-risk for a range of neurodevelopmental delays and/or impairments including motor, cognitive and emotional/behavioural challenges. Research has improved our ability to identify which infants are at high-risk of developmental delay and/or impairments, and there is mounting evidence that early interventions can improve outcomes of these infants. However, clinical practice varies throughout the world regarding recommendations for developmental screening. Moreover, intervention, when available, is often not commenced early enough in development. Given limited resources, those infants most at risk of developmental impairments and their families should be targeted, with further research needed on the cost-effectiveness of surveillance and early interventions.
Collapse
|
14
|
Abstract
Continuous quality improvement (CQI) has become a vital component of newborn medicine. Applying core principles - robust measurement, repeated small tests of change, collaborative learning through data sharing - have led to improvements in care quality, safety, and outcomes in the Neonatal Intensive Care Unit (NICU). High-risk infant follow-up programs (HRIF) have historically aided such quality improvement efforts by providing outcomes data about NICU interventions. Though as a discipline, HRIF has not universally embraced CQI for its own practice. In this review, we summarize the history of CQI in neonatology and applications of improvement science in healthcare and describe examples of CQI in HRIF. We identify the need for consensus on what defines 'high-risk' and constitutes meaningful outcomes. Last, we outline four areas for future investment: establishing evidence-based care delivery systems, standardizing outcomes and their measures, embracing a family-centered approach prioritizing parent goals, and developing professional standards of care for HRIF.
Collapse
Affiliation(s)
- Jonathan S Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center Boston, 330 Brookline Avenue, Rose 3, 02215, Boston, MA, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford School of Medicine, 750 Welch Road, Suite 315, Palo Alto, 94034, Stanford, CA, USA; California Perinatal Quality Care Collaborative-California Children's Services High Risk Infant Follow-Up Quality of Care Initiative, San Francisco, CA, USA.
| |
Collapse
|