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Potentially Better Practices for Follow Through in Neonatal Intensive Care Units
Erika M Edwards1,2,3, Danielle E Y Ehret1,2, Jeffrey D Horbar1,2
1Vermont Oxford Network, Burlington, Vermont.
Insights
NICU teams are adopting new practices to support infant and family social needs, but significant variations exist. Further improvements are needed, especially in for-profit and lower-level NICUs, to ensure equitable care.
Area of Science:
- Neonatal care practices
- Health services research
- Social determinants of health
Background:
- Addressing health-related social needs is crucial for infant and family well-being in the Neonatal Intensive Care Unit (NICU).
- Effective follow-through strategies involve integrating teams, families, and communities as partners.
Purpose of the Study:
- To assess the adoption of potentially better practices (PBPs) for follow-through in US Neonatal Intensive Care Units (NICUs).
- To identify how NICU teams engage families and communities to address infant and family health-related social needs.
Main Methods:
- Analysis of data from 758 US NICUs that completed Vermont Oxford Network data collection in 2023.
- Evaluation of 19 potentially better practices (PBPs) for follow-through published in 2020.
- Stratification of results by safety-net hospital status, hospital ownership, and NICU type.
Main Results:
- 57.5% of NICUs screened for social risks; most offered social work, lactation, and translation services.
- 90.2% assisted families with financial costs; 94.0% connected families with community resources at discharge.
- Adoption of PBPs varied by hospital ownership and NICU level, with a median of 10 PBPs implemented per hospital.
Conclusions:
- US NICUs are implementing a range of follow-through practices, despite resource concerns.
- Significant variation exists in PBP adoption, with lower rates in for-profit and lower-level NICUs, indicating room for improvement.
- Enhanced strategies are needed to ensure comprehensive support for all infants and families in the NICU setting.
Objective:
To ascertain how NICU teams are undertaking action to follow through, involving teams, families, and communities as partners to address health-related social needs of infants and families.
Methods:
Nineteen potentially better practices (PBPs) for follow through first published in 2020 were reported and analyzed as a sum, overall, and by safety-net hospital status, hospital ownership, and NICU type, among US NICUs that finalized Vermont Oxford Network data collection in 2023.
Results:
One hundred percent of 758 eligible hospitals completed the annual membership survey, of which 57.5% reported screening for social risks. Almost all NICUs offered social work, lactation support, and translation services, but only 16% included a lawyer or paralegal on the team. Overall, 90.2% helped families offset financial costs while their infants were in the hospital, either with direct services or vouchers. At discharge, 94.0% of NICUs connected families with appropriate community organizations and services, 52.9% provided telemedicine after discharge, and 11.7% conducted home visits. The median number of PBPs at each hospital was 10 (25th percentile: 8, 75th percentile: 12). The number of PBPs reported differed by hospital control or ownership and level of NICU care. There were no differences by safety-net hospital status.
Conclusions:
Despite concerns about time and resources, a diverse set of US NICUs reported adopting potentially better practices for follow through. However, the marked variation among NICUs and the lower rates at for-profit and lower-level NICUs suggest there is substantial opportunity for improvement.
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