279 - Utilization of Early Outpatient Care for Infants Following Discharge from the Neonatal Intensive Care Unit

Poster Number: 279
Publication Number: 279.1716

Background: Outpatient care after discharge from the Neonatal Intensive Care Unit (NICU) is critical for the safe transfer of care and continued support for high risk infants. Current recommendations suggest initial follow up appointments 1-2 days after discharge. Yet, information is lacking regarding compliance with these recommendations as well as other characteristics of early outpatient care received by NICU infants during this important transition.

Objective: We sought to describe timing, frequency, provider type, risk of readmission, and spending of early outpatient encounters (OPE) occurring within 3 months following discharge.

Design/Methods: This is a secondary data analysis of commercially insured NICU survivors born in all US states from 2015-2017 in the IBM MarketScan Research Database. We examined descriptors of OPE within the first 3 months following discharge. Data were analyzed using descriptive analyses and odds ratios. Missingness was < 1.5%.

Results: 22,214 infants were included, of whom 50% had an OPE within 2 days (quartiles 1,3) following discharge and 90% within 5 days. The median number of OPE in the first three months was 5 (quartiles 4, 7). Infants with NICU diagnoses of chronic lung disease (CLD) and necrotizing enterocolitis/spontaneous intestinal perforation (NEC/SIP) had the highest number of OPE after discharge (median 10 and 8, respectively). Type of initial OPE included physician visits (79.0%) and other encounters (imaging, labs, supplies, nursing, hospice) (19.5%). A majority of first physician visits were with general pediatricians (83.8%), a trend which declined over the first five visits to 71.0% by the fifth OPE; family practice (5.9%), subspecialists (6.8%), and other physicians (5.8%) also provided care. Visits with subspecialists (pulmonologist, surgeon, etc) increased to 17.7% by the fifth physician visit. Infants in the highest quartile of time to first OPE (4-90 days) had an 19% increased risk of readmission by 3 months (OR 1.19, CI [1.07,1.33]). Median spending on OPE for the first 3 months was $1282 for all infants, $1427 for preterm infants, $3507 for infants with CLD, and $3352 for infants with NEC/SIP.

Conclusion(s): Most infants are seen shortly after NICU discharge by general pediatricians. Late initial OPE puts infants at risk for readmission by 3 months. More frequent encounters and increased spending afflict those with chronic conditions. These data can inform safe and well-coordinated discharge planning, particularly for high-risk groups. Future interventions can examine potential barriers to early follow up and identify needed support before NICU discharge.