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Outcomes of Technology Dependent NICU Infants: A Single Center 5-Year Review Comparing Usual Care Versus Comprehensive Medical Care
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A2052 - Outcomes of Technology Dependent NICU Infants: A Single Center 5-Year Review Comparing Usual Care Versus Comprehensive Medical Care
Author Block: W. De Jesus-Rojas, C. Aneji, C. L. Samuels, J. Epean, T. Gonzales, T. S. Harris, J. M. Stark, C. K. Jon, K. E. McBeth, H. Emanuel, A. Yadav, R. A. Mosquera; Pediatric Pulmonary, McGovern Medical School, UTHealth, Houston, TX, United States.
Background: Improved survival of premature infants and with congenital anomalies has led to a growing population of technology dependent children. The use of medical technology introduces additional complexity and increased healthcare utilization to patient care. Prompt comprehensive care using a patient-centered medical home has shown a decrease in serious illness and cost in children with chronic diseases. Outcomes after NICU discharge comparing usual care with comprehensive care in an enhanced medical home remain unclear.
Objective: To compare the outcomes of infants with tracheostomy discharged from NICU in usual care versus comprehensive care.
Methods: A single site retrospective study evaluated forty-nine infants (n=49) discharged from NICU over 5 years (2011-2017) after tracheostomy. 41% of infants received care in the usual medical setting (n=20) and 59% (n=29) received care in a comprehensive medical home at the UTP High-Risk Children’s Clinic. Usual care was provided by pediatricians in consultation with pediatric pulmonary subspecialist for management of respiratory diseases and mechanical ventilation weaning. Comprehensive care was provided by a group of primary care physicians, nurse practitioners and subspecialists. With the comprehensive care approach, a 24 hours provider was accessible over the phone for caretakers and consultation with pediatric subspecialist was promptly available. Infants discharged with DNR status, severe Hypoxic Ischemic Encephalopathy or Central Hypoventilation Syndrome were excluded. Baseline patient demographics, comorbidities, average age of mechanical ventilation liberation, decannulation, and mortality between usual care and comprehensive care groups were determined.
Results: Mortality was significantly lower in the comprehensive care (n=1/29, 3.4%) compared to usual care (n= 11/20, 55%), (OR: 0.29, CI: 0.03-0.25, p=0.00001). Survival analysis shows no difference between groups in readmission rate (RR: -0.60, CI: -1.38-0.17, p=0.13), total of admissions (RR: -0.56, CI: -1.23-0.10, p=0.09), age at mechanical ventilation removal (P=0.32) and decannulation (P=0.23) after NICU discharge. At the end of 5 years, 21% (n=5/23) in comprehensive care versus 14% (n=1/7) required mechanical ventilation. A total of 64% (n=18/28) in comprehensive care compared to 55% (n= 5/9) in usual care continued with a tracheostomy at the conclusion of study. There was no difference in age of mechanical ventilation liberation or decannulation between groups (p=0.66, p=0.63, respectively).
Conclusion: A significant decrease in mortality was achieved following a comprehensive medical care. Due to elevated mortality in usual care, the comprehensive care surviving infants showed comparable outcomes in hospitalization rates and survival analysis revealed no difference between groups in age of decannulation or mechanical ventilation removal.
Author Block: W. De Jesus-Rojas, C. Aneji, C. L. Samuels, J. Epean, T. Gonzales, T. S. Harris, J. M. Stark, C. K. Jon, K. E. McBeth, H. Emanuel, A. Yadav, R. A. Mosquera; Pediatric Pulmonary, McGovern Medical School, UTHealth, Houston, TX, United States.
Background: Improved survival of premature infants and with congenital anomalies has led to a growing population of technology dependent children. The use of medical technology introduces additional complexity and increased healthcare utilization to patient care. Prompt comprehensive care using a patient-centered medical home has shown a decrease in serious illness and cost in children with chronic diseases. Outcomes after NICU discharge comparing usual care with comprehensive care in an enhanced medical home remain unclear.
Objective: To compare the outcomes of infants with tracheostomy discharged from NICU in usual care versus comprehensive care.
Methods: A single site retrospective study evaluated forty-nine infants (n=49) discharged from NICU over 5 years (2011-2017) after tracheostomy. 41% of infants received care in the usual medical setting (n=20) and 59% (n=29) received care in a comprehensive medical home at the UTP High-Risk Children’s Clinic. Usual care was provided by pediatricians in consultation with pediatric pulmonary subspecialist for management of respiratory diseases and mechanical ventilation weaning. Comprehensive care was provided by a group of primary care physicians, nurse practitioners and subspecialists. With the comprehensive care approach, a 24 hours provider was accessible over the phone for caretakers and consultation with pediatric subspecialist was promptly available. Infants discharged with DNR status, severe Hypoxic Ischemic Encephalopathy or Central Hypoventilation Syndrome were excluded. Baseline patient demographics, comorbidities, average age of mechanical ventilation liberation, decannulation, and mortality between usual care and comprehensive care groups were determined.
Results: Mortality was significantly lower in the comprehensive care (n=1/29, 3.4%) compared to usual care (n= 11/20, 55%), (OR: 0.29, CI: 0.03-0.25, p=0.00001). Survival analysis shows no difference between groups in readmission rate (RR: -0.60, CI: -1.38-0.17, p=0.13), total of admissions (RR: -0.56, CI: -1.23-0.10, p=0.09), age at mechanical ventilation removal (P=0.32) and decannulation (P=0.23) after NICU discharge. At the end of 5 years, 21% (n=5/23) in comprehensive care versus 14% (n=1/7) required mechanical ventilation. A total of 64% (n=18/28) in comprehensive care compared to 55% (n= 5/9) in usual care continued with a tracheostomy at the conclusion of study. There was no difference in age of mechanical ventilation liberation or decannulation between groups (p=0.66, p=0.63, respectively).
Conclusion: A significant decrease in mortality was achieved following a comprehensive medical care. Due to elevated mortality in usual care, the comprehensive care surviving infants showed comparable outcomes in hospitalization rates and survival analysis revealed no difference between groups in age of decannulation or mechanical ventilation removal.
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