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Early Readmission following NICU Discharges among a National Sample: Associated Factors and Spending
Janine Bernardo1, Amaris Keiser1, Susan Aucott1
1Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Infants readmitted early after neonatal intensive care unit (NICU) discharge face financial burdens. Term infants transferred to step-down facilities or with congenital anomalies have higher readmission risks, highlighting areas for intervention.
Area of Science:
- Neonatal Intensive Care Unit (NICU) Care
- Pediatric Healthcare Outcomes
- Health Services Research
Background:
- Neonatal intensive care unit (NICU) admissions increase hospital readmission risk for infants.
- Early readmissions pose significant financial and emotional burdens on families.
- Data on modifiable factors and costs associated with early NICU readmissions are limited.
Purpose of the Study:
- To identify demographic and clinical factors associated with early infant readmission after NICU discharge.
- To analyze healthcare payments related to NICU stays and subsequent readmissions.
- To provide insights for preventing early readmissions and optimizing discharge timing.
Main Methods:
- Secondary data analysis of privately insured infants from the IBM MarketScan Research Database (2011-2017).
- Examination of readmission within 7 days and 8-30 days post-NICU discharge.
- Univariate and multivariable logistic regression to identify risk factors and analyze payment data.
Main Results:
- 3.6% of NICU survivors were readmitted within 7 days; 2.5% between 8-30 days.
- Term infants had lower odds of 7-day readmission than preterm infants.
- Transfer to a step-down facility, congenital anomalies, and shorter initial NICU length of stay (LOS) were associated with higher readmission odds.
Conclusions:
- Term infants, those transferred to step-down facilities, and infants with congenital anomalies are at higher risk for early readmission.
- Shorter initial NICU length of stay may contribute to early readmission, particularly in term infants.
- Identifying these risk factors can guide interventions to reduce readmissions, costs, and improve discharge planning.
Objective:
Infants admitted to the neonatal intensive care unit (NICU) are at increased likelihood of hospital readmission when compared with non-NICU admitted infants, resulting in appreciable financial and emotional burdens. Early readmission, days to weeks, following NICU discharge, may be preventable. Population-based data identifying potentially modifiable factors and spending associated with early readmission are lacking.
Study Design:
We conducted a secondary data analysis of privately insured infants in the IBM MarketScan Research Database born from 2011 to 2017 in all 50 states and admitted to the NICU. We examined demographic and clinical characteristics of early readmission within 7 days and between 8 and 30 days following NICU discharge and the payments of NICU and readmission care. Data were analyzed using univariate and multivariable logistic regression.
Results:
Of the 86,741 NICU survivors analyzed, 3,131 infants (3.6%) were readmitted by 7 days and 2,128 infants (2.5%) between 8 and 30 days. Preterm infants had reduced odds of readmission by 7 days compared with term infants. Infants transferred to a step-down facility (vs. discharge home) and those with congenital anomalies had higher independent odds of readmission by 7 and 8 to 30 days. A higher percentage of NICU infants within the lowest quartile of initial NICU length of stay (LOS) were readmitted by 7 days compared with NICU infants in the middle and highest LOS quartiles (64 vs. 36%, p < 0.01). Median payments of readmissions at 7 and 8 to 30 days was $12,785 and 14,380, respectively.
Conclusion:
Being term, being transferred to a step-down facility, and having a congenital anomaly were risk factors for early readmission. Shorter initial NICU LOS may be a contributing factor to readmission by 7 days, especially among term infants. These findings identify factors associated with readmission with the hope of preventing early readmission, minimizing spending, and optimizing ideal timing of NICU discharge.
Key Points:
· Preterm infants were less likely than term infants to be readmitted within 7 days after discharge.. · Transferred infants had higher odds of readmission versus those who were discharged home.. · Payments for an average single NICU day were $1,000 less than for an average day of readmission..
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