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Comprehensive follow-up care and life-threatening illnesses among high-risk infants: A randomized controlled trial
R S Broyles1, J E Tyson, E T Heyne
1University of Texas-Houston Medical School, 6431 Fannin St, MSB 3. 228, Houston, TX 77030-1503, USA.
Insights
Comprehensive care for high-risk infants significantly reduced life-threatening illnesses and intensive care admissions without increasing costs. This approach improves health outcomes for vulnerable urban newborns.
Area of Science:
- Pediatrics
- Health Services Research
- Public Health
Background:
- Inner-city high-risk infants often face fragmented healthcare, increasing their risk of serious illness.
- Limited access to consistent medical care can exacerbate health issues in vulnerable newborns.
Purpose of the Study:
- To determine if comprehensive follow-up care is a cost-effective strategy for reducing life-threatening illnesses in high-risk, inner-city infants.
- To evaluate the impact of enhanced care access on severe health events and healthcare costs.
Main Methods:
- A randomized controlled trial involving 887 very-low-birth-weight infants.
- Infants were assigned to either routine follow-up care or comprehensive care with 24-hour caregiver access.
- Life-threatening illnesses and hospital costs were assessed up to one year of age by blinded evaluators.
Main Results:
- Comprehensive care led to significantly fewer life-threatening illnesses (48% reduction), intensive care admissions (57% reduction), and intensive care days (42% reduction).
- Despite increased clinic visits and phone calls, comprehensive care did not increase overall estimated costs per infant.
- Fewer infants in the comprehensive care group had unknown one-year outcomes compared to the routine care group.
Conclusions:
- Comprehensive follow-up care provided by experienced caregivers is effective in reducing severe illness in high-risk inner-city infants.
- This enhanced care model improves infant health outcomes without incurring additional healthcare expenses.
- The study supports the implementation of comprehensive care programs for vulnerable urban infant populations.
Context:
Inner-city high-risk infants often receive limited and fragmented care, a problem that may increase serious illness.
Objective:
To assess whether access to comprehensive care in a follow-up clinic is cost-effective in reducing life-threatening illnesses among high-risk, inner-city infants.
Design:
Randomized controlled trial.
Setting And Participants:
A total of 887 very-low-birth-weight infants born in a Texas county hospital between January 1988 and March 1996 and followed up in a children's hospital clinic. One hundred four infants who became ineligible or died after randomization but before nursery discharge were excluded from the analysis.
Interventions:
Infants were randomly assigned to receive routine follow-up care (well-baby care and care for chronic illnesses; n = 441) or comprehensive care (which included the components of routine care plus care for acute illnesses, with 24-hour access to a primary caregiver; n = 446).
Main Outcome Measures:
Life-threatening illnesses (ie, causing death or hospital admission for pediatric intensive care) occurring between nursery discharge and age 1 year, assessed by blinded evaluators from inpatient charts and state Medicaid and vital statistics records; and hospital costs (estimated from department-specific cost-to-charge ratios).
Results:
Comprehensive care resulted in a mean of 3.1 more clinic visits and 6.7 more telephone conversations with clinic staff (P<.001 for both). One-year outcomes were unknown for fewer comprehensive-care infants than routine-care infants (9 vs 28; P =.001). Identified deaths were similar (11 in comprehensive care vs 13 in routine care; P =.68). The comprehensive-care group had 48% fewer life-threatening illnesses (33 vs 63; P<.001), 57% fewer intensive care admissions (23 vs 53; P =.003), and 42% fewer intensive care days (254 vs 440; P =.003). Comprehensive care did not increase the mean estimated cost per infant for all care ($6265 with comprehensive care and $9913 with routine care).
Conclusion:
Comprehensive follow-up care by experienced caregivers can be highly effective in reducing life-threatening illness without increasing costs among high-risk inner-city infants. JAMA. 2000;284:2070-2076.
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