K. J. Baxter1,2, H. T. Nguyen1,2, M. L. Wulkan1,2, M. V. Raval1,2 1Emory University School Of Medicine,Atlanta, GA, USA 2Children’s Healthcare Of Atlanta,Pediatric Surgery,Atlanta, GA, USA
Introduction: After discharge from the neonatal intensive care unit (NICU), continuity through utilization of primary care is an important factor in coordination and readmission prevention. Utilization in this complex population has not been well-characterized. We sought to quantify utilization and to examine its association with readmission in these patients.
Methods: The Truven MarketScan national insurance claims database was used to conduct a retrospective cohort study. Inclusion criteria were patients with an initial admission to the NICU for ≥30 days and discharged to home. We then measured the number and frequency over time of outpatient encounters after discharge, and readmission to the hospital within 90 days of discharge. Patient comorbidities were compared using chi square tests between those readmitted and non-readmitted.
Results: We identified a total of 13,737 NICU patients. Of these, 1,659 (12.1%) were readmitted within 90 days. As the number of outpatient encounters per week increased, the percentage of patients readmitted increased substantially with an 85% readmission rate for patients with >3 visits/week (Figure). However, these high-utilizers represent a small proportion of the overall cohort, as 98.1% had <2 outpatient visits/week. Readmitted patients compared to non-readmitted patients were significantly more likely to have neuromuscular (7.7 vs. 4.5%, p<0.01), respiratory (17.9 vs. 13.4%, p<0.01), gastrointestinal (4.0 vs. 1.8%, p<0.01), hematologic (1.0 vs. 0.5%, p<0.01) and other congenital or genetic comorbidities (8.0 vs. 3.8%, p<0.01), but were less likely to have cardiovascular diagnoses (31.1 vs. 42.4%, p<0.01).
Conclusion: We demonstrate that frequent outpatient healthcare utilization is a strong indicator of impending hospital readmission after NICU discharge. However, the overall readmission rate for these children is relatively low given their high burden of comorbid conditions. Cardiac patients were less likely to be readmitted, perhaps due to longer length of stay or specialized discharge strategies. More study is needed to determine the optimal frequency of primary care visits in these complex patients.
