256 - Characteristics of Early Home Health Care Following Discharge from the Neonatal Intensive Care Unit

Poster Number: 256
Publication Number: 256.1740

Background: Home health care (HHC) is an important service provided to neonates following discharge from the Neonatal Intensive Care Unit (NICU), yet characterization of these services is understudied.

Objective: We describe characteristics of HHC, including utilization, frequency, association with readmission, and spending for services, which may be useful in determining how these services may be optimally utilized.

Design/Methods: Data were analyzed from the IBM Marketscan Research Database which includes claims data from commercially insured infants admitted to NICUs nationally. We examined descriptors of HHC within the first three months following discharge for infants born between 2015-2017. Data were analyzed using descriptive statistics, chi-square, and logistic regression.

Results: 22,214 NICU survivors were included, of whom 8.2% had at least one home health visit during the first three months following NICU discharge. The median number of HHC visits was 2 (1,4; quartiles). A significantly higher proportion of infants who had any HHC lived in the Northeast, were born in 2015, and were preterm (Table 1). In addition, more infants with HHC had chronic NICU diagnoses (congenital anomaly, chronic lung disease [CLD], necrotizing enterocolitis/spontaneous intestinal perforation [NEC/SIP] congenital heart disease [CHD], neurologic injury (severe intraventricular hemorrhage [IVH], periventricular leukomalacia [PVL], hypoxic-ischemic encephalopathy [HIE]), or were discharged with equipment than those without HHC (Table 1). Infants who had at least one HHC visit had a 90% increased risk of readmission by three months following discharge when compared to infants who did not have HHC (OR 1.90, CI [1.64, 2.19]); NEC/SIP (OR 2.24, CI[1.45, 3.45]) and congenital anomalies (OR 2.87, CI[2.59, 3.17]) were also independent predictors of readmission. Median total spending on HHC in the first three months following discharge was $3149 (Range 1654, 6463) and was higher for infants with CLD ($5953), NEC/SIP ($8426), brain injury ($5027) and congenital anomaly ($4759).

Conclusion(s): HHC services were utilized by a minority of infants following NICU discharge. Preterm infants and those with chronic medical diagnoses had higher utilization of HHC. HHC was associated with higher risk of readmission due to chronic conditions and likely more vigilance from providers. Future work should include children with public insurance, reasons for HHC, explanations why so few NICU survivors receive HHC, and the role of HHC in other outcomes like immunization rates, health care by subspecialists, and support for families.