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Management of medically fragile infants and children
P F Scholtes1, J Sherman, M Griffin
1HHC Health Group, Inc., Irvine, CA.
Insights
A new home care program, "Welcome Home," improved care quality and reduced costs for medically fragile infants. This case management approach supports crucial parent-child bonding beyond the neonatal intensive care unit (NICU).
Area of Science:
- Pediatrics
- Healthcare Management
- Child Development
Background:
- Medically fragile infants and children require specialized care, often in Neonatal Intensive Care Units (NICUs).
- NICUs may not fully support the developmental and psychosocial needs of infants and parents, impacting bonding.
- High costs and prolonged stays in NICUs present significant financial and logistical challenges.
Purpose of the Study:
- To evaluate the implementation and impact of an innovative case management-oriented home care program for medically fragile infants.
- To assess the program's effect on the quality of care and associated costs.
- To address the limitations of Neonatal Intensive Care Units in meeting developmental and psychosocial needs.
Main Methods:
- Implementation of the "Welcome Home" program by FHP Utah, a managed care organization.
- Focus on case management to coordinate home care services.
- Summarization of the first year of program operation and outcomes.
Main Results:
- The "Welcome Home" program demonstrated a significant positive impact on the quality of care for medically fragile infants.
- The program led to a substantial reduction in the overall cost of care.
- Facilitated improved psychosocial bonding between infants and parents by transitioning care to the home environment.
Conclusions:
- Home care programs, particularly those with a case management focus, can effectively manage medically fragile infants.
- "Welcome Home" offers a viable alternative to prolonged NICU stays, enhancing both care quality and cost-efficiency.
- Transitioning care to the home environment supports critical developmental and parental bonding needs.
Abstract:
Medically fragile infants and children present a host of challenges. The neonatal intensive care unit (NICU) is initially the mainstay of care for these infants, but it does not meet the critical developmental interactive needs of the child and parents to ensure positive psychosocial bonding. The care of these infants is further complicated by high daily costs (ranging from $1,000 to $2,500 per neonatal intensive care bed day) and lengthy, expensive inpatient stays (typically ranging from one week to five months or more). FHP Utah, a managed care organization, met these challenges through an innovative case management-oriented home care program called "Welcome Home." The program has produced a major impact on the quality and the cost of care for medically fragile infants. This article summarizes the first year's experience in implementing and operating the program.