Preterm birth is a serious health problem that costs the nation more than $26 billion annually, according to the Institute of Medicine. While it has long been known that early preterm infants have increased risk of rehospitalization, recent data indicate that the increased risk of adverse outcomes associated with prematurity, including rehospitalization, extend to moderate and late preterm infants.
So how can we best care for these vulnerable infants and their mothers to reduce the incidence of complications and costly rehospitalizations?
Research led by Betty R. Vohr, MD, director of Women & Infants’ Neonatal Follow-Up Program and professor of pediatrics at The Warren Alpert Medical School of Brown University, entitled “Impact of a Transition Home Program on Rehospitalization Rates of Preterm Infants,” has been published in The Journal of Pediatrics. The research team also includes Women & Infants/Brown University colleagues Elisabeth McGowan, MD; Lenore Keszler, MD; Barbara Alksninis, PNP, NNP; Melissa O’Donnell, B>A, MSW; Katheleen Hawes, PhD, RN; and Richard Tucker, BA.
“Our primary objective was to evaluate the effects of an enhanced transition home program for families with social workers and family resource specialists (FRS) as team members to decrease the rate of rehospitalization in preterm infants cared for in a neonatal intensive care unit (NICU) for greater than five days. Secondarily, we sought to identify key maternal and infant social/environmental and medical risk factors associated with rehospitalization,” explained Dr. Vohr. “Three factors that almost doubled the risk of rehospitalization were Medicaid insurance as a marker of poverty, non-English speaking, and a history of more than one pregnancy, and the most common cause of rehospitalization was respiratory. Rehospitalization is a major concern since it results in both increased stress/emotional costs and health care costs.”
Dr. Vohr continued, “The good news is that the study demonstrated a 42 percent decreased risk of rehospitalization over the three-year period. We believe the success of the transition home program is related to providing comprehensive, family-centered care for both the infant and mother in a four-pronged approach of psychosocial support, parent education, medical support continuing post discharge, and enhanced partnering with parents, NICU staff and community providers. Expansion of comprehensive, family-centered, individualized transition home programs provided by teams which include FRS and social workers is needed to decrease morbidity and cost.”
This research was supported by a 2012 $3.2 million by a Health Care Innovation Award from the Centers for Medicare and Medicaid Services (CMS) which enabled the expansion of Women & Infants’ Transition Home Plus Program to 1,391 infants and their mothers in the NICU. Under the leadership of Dr. Vohr, the intervention program trained and deployed family care teams to offer education and support, monitoring of infants’ growth and development, and support for primary care providers who help care for this at-risk population.
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