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Care Coordination Associated with Improved Timing of Newborn Primary Care Visits
Neera K Goyal1,2,3,4, Eric S Hall5,6, Robert S Kahn5,7
1Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. ML# 7009, Cincinnati, OH, USA. neera.goyal@cchmc.org.
Insights
Care coordination significantly improves timely newborn follow-up appointments, especially for low-income families. This enhances adherence to essential post-birth healthcare recommendations.
Area of Science:
- Pediatrics
- Healthcare Management
- Public Health
Background:
- Post-discharge newborn follow-up within 3-5 days is recommended but often not achieved.
- Factors influencing timely newborn care coordination require further investigation.
Purpose of the Study:
- To determine the association between care coordination programs and the timing of newborn follow-up appointments.
- To assess the impact of discharge and primary care coordination on adherence to recommended newborn care.
Main Methods:
- Retrospective study of 6251 newborns across eight maternity hospitals.
- Sequential implementation of newborn discharge coordination and primary care intake coordination programs.
- Analysis of days between discharge and follow-up, rescheduled appointments, and loss to follow-up using regression models.
Main Results:
- Only 52.9% of newborns attended follow-up within 5 days (mean 6.7 days).
- Care coordination programs increased the likelihood of recommended follow-up by 72% (discharge coordination) and 33% (primary care coordination).
- Primary care coordination reduced the odds of loss to follow-up by 13% monthly.
Conclusions:
- Care coordination strategies demonstrably improve timely newborn follow-up adherence.
- These interventions are particularly beneficial for low-income families.
- Enhanced coordination positively impacts newborn healthcare access and reduces follow-up attrition.
Abstract:
Objective Despite practice recommendations that all newborns be examined within 3-5 days after discharge, many are not seen within this timeframe. Our objective was to determine the association between care coordination and timing of newborn follow-up. Methods This retrospective study evaluated 6251 newborns from eight maternity hospitals who scheduled a primary care appointment at one of two academic pediatric practices over 3.5 years. Two programs were sequentially implemented: (1) newborn discharge coordination, and (2) primary care intake coordination. Primary outcome was days between discharge and follow-up, dichotomized as ≤ or >5 days. Number of rescheduled appointments and loss to follow-up were also assessed. Adjusted relative risks (RR) and odds ratios (OR) were determined by piecewise generalized linear and logistic regression. Results Among 5943 newborns with a completed visit, 52.9 % were seen within 5 days of discharge (mean 6.7 days). After multivariable adjustment, the pre-exposure period (8 months) demonstrated a downward monthly trend in completing early follow-up (RR 0.93, p < 0.001). After initial program implementation, we observed a 3 % monthly increase (RR 1.03, p < 0.001 for test of slope change from pre-exposure to post-exposure), such that likelihood of recommended follow-up increased by roughly 72 % after discharge coordinator implementation and roughly 33 % after primary care coordinator implementation. The latter was also associated with a 13 % monthly decrease in odds of loss to follow-up (OR 0.87, p < 0.001). Conclusions for Practice Care coordination increases adherence among low income families to recommended newborn follow-up after birth hospitalization.
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