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Standardized Neurodevelopmental Surveillance of High-risk Infants Using Telehealth: Implementation Study during
Nathalie L Maitre1,2,3, Kristen L Benninger1, Mary Lauren Neel1
1Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Telehealth neurodevelopmental surveillance effectively provided standardized care for high-risk infants post-NICU discharge. This model improved provider efficiency and reduced missed visits, demonstrating its value during the COVID-19 pandemic.
Area of Science:
- Pediatrics
- Health Services Research
- Implementation Science
Background:
- Neurodevelopmental surveillance for high-risk infants is crucial after neonatal intensive care unit (NICU) discharge.
- Traditional in-person surveillance was disrupted by the COVID-19 pandemic, necessitating telehealth solutions.
- Rapid development of telehealth models was required for continued standardized care.
Purpose of the Study:
- To develop and implement an effective telehealth neurodevelopmental surveillance program for high-risk infants.
- To assess the feasibility, satisfaction, and clinical outcomes of telehealth surveillance compared to in-person visits.
- To evaluate the impact of telehealth on process metrics and provider efficiency.
Main Methods:
- Utilized implementation science and lean methodologies to design the telehealth program.
- Incorporated a telehealth toolkit for standardized neurological and developmental assessments.
- Employed plan-do-study-act cycles, value-added analysis, and satisfaction surveys for iterative improvement.
- Compared process metrics and balancing measures between telehealth and in-person cohorts using group-level analyses and run charts.
Main Results:
- Achieved 100% visit completion with over 90% parent satisfaction regarding telehealth procedures.
- No statistical difference in the ability to diagnose cerebral palsy compared to in-person visits.
- Telehealth visits showed no significant differences in standard process metrics compared to in-person visits.
- Provider efficiency increased to near baseline, and missed visits decreased from 20% to 0%.
Conclusions:
- Telehealth implementation successfully provided standardized and timely neurodevelopmental surveillance for high-risk infants during public health restrictions.
- The telehealth model proved effective in maintaining care quality and improving operational efficiency.
- Broader application of telehealth in neurodevelopmental surveillance may help overcome existing access barriers.
Introduction:
Neurodevelopmental surveillance is critical for high-risk infants following neonatal intensive care discharge and is traditionally performed in-person. COVID-19 interruption of regular surveillance necessitated a rapid development of telehealth models for effective and standardized care.
Methods:
We used implementation science and lean methodologies to develop an effective telehealth neurodevelopmental surveillance program for high-risk infants. Interventions included reorganization of visit flow processes and a telehealth toolkit for standardized neurological and developmental assessments. We tested and improved our intervention through plan-do-study-act cycles, value-added analysis, and parent- and provider-satisfaction questionnaires. Process metrics (standard elements, subspecialty referrals, diagnostic tests, and prescriptions ordered) were compared in group-level analyses between telehealth patients (N = 97) March 16, 2020-July 1, 2020 and a matched in-person cohort at the same period the previous year. Run charts examined shifts in balancing measures (provider efficiency and missed visits) over 8 weeks before and after implementation.
Results:
Primary outcomes were visit completion (100%), patient parent satisfaction (>90% strongly agreed or agreed telehealth procedures were valuable and easy to use) and ability to accurately diagnose cerebral palsy (no statistical difference with comparison visits). Providers (N = 6) rated telehealth experiences favorably. Process metrics indicated no differences between telehealth and in-person visits (all P > 0.05). Following telehealth implementation, provider efficiency increased to near baseline (median 88.9% versus 91.7%) and median missed visits decreased to 0% from 20% (in-person).
Conclusions:
Implementation of telehealth for neurodevelopmental surveillance in a tertiary high-risk infant follow-up clinic successfully provided standardized and timely care during stay-at-home orders; broader telehealth applications may overcome access barriers in this field.
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