Outcomes for high-risk neonates in a managed care clinical system

The purpose of this study was to compare a conventional system and a managed care clinical system for the care of high-risk neonates. The variables selected for the comparison of these two systems included neurobehavioral organization as evidenced by feeding behaviors, length of stay, severity of illness, readmissions, and cost of care. The sample consisted of 260 neonates (111 in the conventional system, 149 in the managed care system). In addition, two neonatal diagnosis-related groups were selected: 386 (extreme immaturity) and 387 (prematurity with major problems). Findings showed that the managed care clinical system enhanced neurobehavioral organization specifically in the feeding behaviors by reducing the number of days needed to master oral feedings. Although there was an increase in complications, costs were controlled.