Improving health care usage in a very low birth weight population
Wambui Waruingi, Sai Iyer, Marc Collin
Cleveland, USA
Author Affiliations: Department of Pediatrics, Division of Neonatology, Case Western Reserve, Metrohealth Medical Center, 2500 Metrohealth Drive, Cleveland, OH 44109, USA (Waruingi W, Iyer S, Collin M); Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnett avenue, Cincinnati, OH 45229, USA (Waruingi W)
Corresponding Author: Wambui Waruingi, Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati OH 45229, USA (Tel: 440-5030729; Fax: 513-862-4979; Email: wwambui@msn.com)
doi: 10.1007/s12519-014-0492-y
Online First June 2014.
Background: Prematurity is the biggest contributor to admissions in the neonatal intensive care unit (NICU). The period following hospital discharge is a vital continuum for the very low birth weight (VLBW) infant. The objective of this study was to assess the impact of a unique discharge and follow-up process on the outcomes of VLBW infants leaving the NICU.
Methods: All outpatient health care usage by VLBW infants born in the study year (cases) was retrospectively tracked through 12 months of age. A cohort of healthy newborn infants were matched by birthdate to each VLBW infant (controls) and similarly tracked.
Results: In this study, there were 85 cases and 85 controls. The mean gestational age at birth for the cases was 29.1¡À2.7 weeks with a mean birth weight of 1079¡À263 g. That of the controls was 38.9¡À1.3 weeks and 3202¡À447 g. Over 90% of both populations had Medicaid coverage. All VLBW infants received care at the Special Care Developmental Follow-Up Clinic. When compared with the controls, VLBW infants discharged from the NICU made fewer acute, unscheduled visits to the Emergency Department or Urgent Care Clinic (2.3¡À2.5 vs. 3.7¡À3.5; P=0.007) despite their high-risk medical and social status. Their growth pattern showed significant "catch-up" and was similar to the matched controls at the last scheduled visit for each group.
Conclusions: Outcomes including health care utilization in high-risk infants can be improved through meticulous discharge planning and follow-up measures that utilize existing hospital infrastructure to provide affordable comprehensive care.
World J Pediatr 2015;11(3):239-244
Key words: health care usage; special care clinic; very low birth weight
