87 - Extremely Preterm Infants Have Continued Intensive Healthcare Contact Days After NICU Discharge

Publication Number: 3083.87

Nisha Dalvie, Boston Children's Hospital, Somerville, MA, United States; Matt hall, Children's Hospital Association, Lenexa, KS, United States; James M.. Perrin, MassGeneral Brigham for Children; Harvard Medical School, Boston, MA, United States; Cara L. Coleman, Virginia Medicine, INOVA Campus, Occoquan, VA, United States; Jonathan S. Litt, Stanford University School of Medicine, Palo Alto, CA, United States; Jay Berry, Boston Children's Hospital, Jamaica Plain, MA, United States

Background: Families of extremely preterm infants report feeling unprepared for their healthcare experiences after discharge from the neonatal intensive care unit (NICU). This is especially true for infants who rely on durable medical equipment and supplies (DMES) at home. Many families face challenges with cognitive load required manage the different facets of outpatient care. Quantifying the intensity of ongoing care required after NICU discharge will help prepare families for life at home, design high-value models of care, and identify actionable systems inefficiencies.

Objective: To measure healthcare contact days (HCDs) for preterm infants in their first year after NICU discharge and assess the relationship between DMES use and HCDs.

Design/Methods: Retrospective analysis of 4,545 infants < 28 weeks' gestational age discharged to home from NICUs between 2016-2023 in 12 U.S. states included in the Merative Marketscan Medicaid database. HCDs (measured to one year after discharge) were calendar days with at least one healthcare claim from any health service across the continuum. Inpatient days (using length of stay if readmitted) and pharmacy days (using prescription claim dates) were separated. Respiratory, gastrointestinal, and nutrition DMES used in the home within 2 months of NICU discharge were distinguished with HCPCS codes. HCDs were compared by DMES type and count using Wilcoxon Rank Sum and Poisson regression.

Results: Median [interquartile range (IQR)] HCDs within 1 year of NICU discharge for extremely preterm infants was 35 (21-61); non-inpatient claims accounted for most HCDs. Fifty-nine percent of infants used home DMES; nebulizer (49%) and oxygen (45%) were the most common DMES. HCDs increased significantly (p <.001) with increasing count of home DMES, ranging from median 22 (IQR 13-36) days for no DMES to median 155 (IQR 99-177) for <=7 DMES (Figure 1). Tracheostomies [median 242 (IQR 127-317)], ventilators [median 295.5 (IQR 234-329)], and parenteral nutrition [median 218 (IQR 186-268)] were associated with the highest number of HCDs (Table 1). In multivariable analysis, use of >=7 DMES vs. no DMES was associated with the highest adjusted rate ratio of HCDs [3.9 (95%CI 3.3-4.6)].

Conclusion(s): Most extremely preterm infants on Medicaid experienced several weeks' worth of HCDs in their first year after NICU discharge. Type and count of home DMES correlated strongly with the number of HCD. Further investigation is needed to assess how DMES information and projected HCDs can lead to better care coordination, more efficient care systems, and effective supports for parents during the transition to home.

Figure 1. Total Median Healthcare Contact Days in the First Year after NICU Discharge by Durable Medical Equipment and Supply Use
Box-and-whisker plot of total median healthcare contact days by DMES organ system, DMES organ system count, and individual DMES count. Colored bars indicate 25th to 75th percentile (interquartile) range of days. Thick line indicates the median total days. Whiskers indicate 10th to 90th percentile range of days.

Table 1. Healthcare Contact Days in the First Year after NICU Discharge by Specific Durable Medical Equipment and Supply Use
Table displaying total median contact days, median inpatient contact days, and median pharmacy contact days by DMES use. Specific types of DMES are not mutually exclusive - patients were included in multiple categories if they had multiple DMES.