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Hospital-based case management for medically fragile infants: results of a randomized trial
Insights
Case management services significantly improve access to community health and developmental services for medically fragile infants. This family-centered approach enhances early intervention outcomes during the critical first six months of life.
Area of Science:
- Neonatal care
- Pediatric developmental assessment
- Early intervention services
Background:
- Federal legislation expanded eligibility for multidisciplinary evaluations for infants with developmental delays.
- Advances in neonatal intensive care (NICU) have increased survival rates for high-risk infants.
- Increased survival necessitates enhanced family education and counseling for health and developmental interventions.
Purpose of the Study:
- To compare a hospital-based case management team's services with traditional Neonatal Intensive Care Unit (NICU) discharge and follow-up services.
- To evaluate the impact of different service models on family access to community-based health and developmental services.
- To assess developmental benefits for medically fragile infants receiving early intervention.
Main Methods:
- Study included the 10% most medically severe infants discharged from a NICU over 16 months.
- Comparison between a case management team and traditional NICU follow-up services.
- Analysis of family access to coordinated, community-based health and developmental services.
Main Results:
- Families receiving case management services showed significantly greater access to community-based health and developmental services.
- Traditional models typically referred the most medically severe 3% of infants.
- An additional 7% of infants referred under the transition model demonstrated greater developmental benefits in the first six months.
Conclusions:
- Case management models enhance family engagement with crucial early intervention services.
- Transitioning to community-based, coordinated care benefits a broader range of medically fragile infants.
- Findings support federal initiatives promoting family-centered, community-based early intervention programs.
Abstract:
A recent federal law has expanded the eligibility for multidisciplinary evaluation and assessment of infants suspected of developmental delay. At the same time, modern neonatal care has increased infant survival. These two developments have created a need for family education regarding the need for health and developmental intervention, as well as counseling to maintain family participation in these services. This study compares the education and counseling services of a hospital-based case management team with the traditional discharge and follow-up services of a neonatal intensive care unit (NICU). Subjects were the 10% most medically severe infants discharged from a neonatal intensive care unit over a 16-month period. Preliminary data suggests a significantly greater number of families accessed community-based, coordinated, comprehensive health and developmental services when they received case management services. The data suggest that hospital professionals generally refer the most medically severe 3% of this group for services under a traditional model. However, the additional 7% referred under the transition model showed greater developmental benefits from the services during the first 6 months of life. These data support current federal initiatives for early intervention services which are family-centered, community-based and coordinated.
