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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Resource Use and Costs of Nurse Navigator Support for Parents of High-Risk Infants After Discharge from a Neonatal
Vercancy Wu1, Myla E Moretti1,2, Kayla Esser1
1Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON M5G 0A4, Canada.
Insights
The Coached, Coordinated, Enhanced Neonatal Transition (CCENT) program supports high-risk infants after NICU discharge. While not increasing overall healthcare costs, it may improve family access to appropriate care.
Area of Science:
- Neonatal intensive care unit (NICU) transitions
- Healthcare resource utilization
- Health economics
Background:
- Infants discharged from NICU often have complex ongoing medical needs.
- The Coached, Coordinated, Enhanced Neonatal Transition (CCENT) program offers nurse navigator support for high-risk infants post-discharge.
- Evaluating healthcare resource use and costs is crucial for NICU transition interventions.
Purpose of the Study:
- To compare healthcare resource use and costs between the CCENT program and standard care.
- To analyze costs from both public healthcare system and family payer perspectives.
- To assess the impact of the CCENT program on infant healthcare utilization and parent mental health service use.
Main Methods:
- A randomized controlled trial comparing CCENT to standard care across Canada.
- Data collection on resource use and costs at 4 and 12 months post-discharge.
- Statistical analysis of healthcare utilization, service use, and costs between and within groups over time.
Main Results:
- Total annual healthcare costs per child to the public payer were comparable between CCENT ($4135) and control ($4578) groups.
- The cost of delivering CCENT was $669 per family, with similar average annual out-of-pocket costs for both groups.
- While medication and equipment use decreased, allied health professional use declined and emergency department visits increased in the CCENT group.
Conclusions:
- The CCENT program's costs to the healthcare system were not significantly increased when excluding the nurse navigator.
- Implementing NICU to home care interventions requires consideration of healthcare utilization patterns, program costs, and family financial impact.
- The CCENT program shows potential in assisting families to access necessary and appropriate care post-NICU discharge.
Abstract:
Background: Infants discharged home from a neonatal intensive care unit (NICU) often have multiple ongoing medical needs. The Coached, Coordinated, Enhanced Neonatal Transition (CCENT) program provides nurse navigator-led support for caregivers of high-risk infants through their first year after transitioning from the NICU to home. The objective was to compare health care resource use and costs between CCENT and standard care control groups post-discharge. Methods: Resource use and costs were collected at 4 months and 12 months post-discharge from families enrolled in the CCENT randomized controlled trial across Canada. Infant healthcare utilization and parent mental health service use and costs were analyzed from public health care system and family payer perspectives and were compared statistically between groups and within groups over time. Results: A total of 97 and 105 infants were randomized to the intervention and control groups, respectively. Significant reductions in use of medications and equipment were observed over time in both groups while use of allied health professionals decreased and emergency department (ED) visits increased for CCENT. Annual total healthcare costs per child to the public payer were $4135 (95% CI $2825, $5709) for the CCENT group and $4578 (95% CI $2246, $8356) for controls. The cost of delivering CCENT was $669 per family (SD $362). The average annual out-of-pocket cost per family was $724 (95% CI $467, $1024) for CCENT and $728 (95% CI $479, $1007) for controls. Conclusions: This study indicates the importance of considering patterns of healthcare utilization, program costs and costs to families when implementing NICU to home care interventions. Excluding the cost of a nurse navigator, costs to the healthcare system were not increased in the intervention group. Such a program may help families access appropriate care.
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