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Published on: January 7, 2020
Care System Redesign for Preterm Children After Discharge From the NICU
Dennis Z Kuo1, Robert E Lyle2,3, Patrick H Casey2,3
1Department of Pediatrics, University at Buffalo, Buffalo, New York; dkuo@upa.chob.edu.
Insights
Improving care for preterm infants after NICU discharge is crucial. A redesigned health system, focusing on community-based care and chronic condition management, can enhance wellness and reduce long-term costs for these vulnerable children.
Area of Science:
- Pediatrics
- Health Services Research
- Public Health
Background:
- Preterm birth affects approximately 1 in 8 US children, posing risks for increased healthcare utilization and societal costs post-Neonatal Intensive Care Unit (NICU) discharge.
- Current guidelines primarily focus on NICU stays and immediate post-discharge surveillance, with limited attention to ongoing community-based health promotion for preterm infants.
- Fragmented healthcare delivery and a lack of guidance for community providers managing NICU graduates contribute to suboptimal outcomes.
Purpose of the Study:
- To propose a framework for redesigning healthcare systems to better support the health and wellness of children born preterm after NICU discharge.
- To highlight the need for a proactive, community-centered approach to managing the long-term needs of NICU graduates.
- To provide practical strategies for physicians and healthcare systems to improve care coordination and outcomes for this population.
Main Methods:
- Utilizing principles from chronic care models and practice transformation.
- Presenting a framework for health system redesign tailored to the unique needs of NICU graduates.
- Discussing the rationale for prioritizing NICU graduates within health system redesign initiatives.
Main Results:
- A proposed framework emphasizes population health management through patient-centered medical homes.
- Integration of comanagement and clinical support from tertiary care centers is recommended.
- A supportive payer strategy focused on chronic care management is identified as essential.
Conclusions:
- Redesigning healthcare systems to incorporate community-based, chronic care management is vital for improving the health and development of preterm infants.
- Effective management requires collaboration between patient-centered medical homes, tertiary care centers, and payers.
- Implementing this framework can lead to improved growth, health, development, and reduced healthcare costs for NICU graduates.
Abstract:
Approximately 1 in 8 children in the United States are born preterm. Existing guidelines and research examine the cost of prematurity from the NICU stay and developmental surveillance and outcomes after discharge from the NICU. Preterm children are at greater risk for excess hospitalizations, outpatient visits, and societal costs after NICU discharge. Improved delivery of care and health promotion from the community setting, particularly from the patient-centered medical home, may result in improved growth, health, and development, with accompanying reduction of post-NICU discharge costs and encounters. There has been comparatively little focus on how to promote health and wellness for children born preterm, particularly for community-based providers and payers. Accordingly, health care delivery for NICU graduates is often fragmented, with little guidance on medical management beyond tertiary care follow-up. In this article, we use what is known about chronic care and practice transformation models to present a framework for health care system redesign for children born preterm. We discuss the rationale for NICU graduates as a priority population for health system redesign. Promotion of health and wellness for children born preterm who are discharged to the community setting entails population health management from the patient-centered medical home; comanagement, clinical care protocols, and clinical support from the tertiary care-based tertiary care-based center; and a favorable payer strategy that emphasizes support for chronic care management. Practical suggestions are provided for the practicing physician for the child born preterm as health care systems are redesigned.
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