Impact of a Transition Home Program on Rehospitalization Rates of Preterm Infants

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• 作者：Betty Vohr ; MD¹ ; ² ; ^{bvohr@wihri.org} ; Elisabeth McGowan ; MD¹ ; ² ; Lenore Keszler ; MD¹ ; ² ; Barbara Alksninis ; PNP ; NNP¹ ; Melissa O'Donnell ; BA ; MSW¹ ; Katheleen Hawes ; PhD ; RN¹ ; ² ; ³ ; Richard Tucker ; BA¹
• 关键词：peer counselors ; social risk ; environmental risk ; health insurance
• 刊名：The Journal of Pediatrics
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：181
• 期：Complete
• 页码：86-92.e1
• 全文大小：197 K
• 卷排序：181

文摘

To evaluate the effects of a transition home program on 90-day rehospitalization rates of preterm (PT) infants born at <37 weeks gestational age implemented over 3 years for infants with Medicaid and private insurance, and to identify the impact of social/environmental and medical risk factors on rehospitalization.Study designIn this prospective cohort study of 954 early, moderate, and late PT infants, all families received comprehensive transition home services provided by social workers and family resource specialists (trained peers) working with the medical team. Rehospitalization data were obtained from a statewide database and parent reports. Group comparisons were made by insurance type. Regression models were run to identify factors associated with rehospitalization and duration of rehospitalization.ResultsIn bivariable analyses, Medicaid was associated with more infants hospitalized, more than 1 hospitalization, and more days of hospitalization. Early PT infants had more rehospitalizations by 90 days than moderate (P = .05) or late PT infants (P = .01). In regression modeling, year 3 of the transition home program vs year 1 was associated with a lower risk for rehospitalization by 90 days (OR, 0.57; 95% CI, 0.36-0.93; P = .03). Medicaid (P = .04), non–English-speaking (P = .02), multiple pregnancies (P = .05), and bronchopulmonary dysplasia (P = .001) were associated with increased risk. Both bronchopulmonary dysplasia and Medicaid were associated with increased days of rehospitalization in adjusted analyses. The major cause of rehospitalization was respiratory illness (61%).ConclusionsTransition home prevention strategies must be directed at both social/environmental and medical risk factors to decrease the risk of rehospitalization.