The Effect of Comprehensive Medical Care on the Long-Term Outcomes of Children Discharged from the NICU with Tracheostomy

TLDR

Survival of infants with complex care has created a growing population of technology‑dependent children, whose care is complicated by medical technology. The study compares post‑NICU discharge outcomes of technology‑dependent infants with tracheostomy under usual care versus comprehensive care. A retrospective single‑site study of 43 infants used a comprehensive care model that offered 24‑hour access to healthcare providers through an enhanced medical home. Comprehensive care markedly reduced mortality (3.4% vs 35.7%), hospital admissions (78 vs 162 per 100 child‑years), and time to mechanical ventilation liberation, while readmission rates and decannulation times were not significantly different.

Abstract

Survival of infants with complex care has led to a growing population of technology-dependent children. Medical technology introduces additional complexity to patient care. Outcomes after NICU discharge comparing Usual Care (UC) with Comprehensive Care (CC) remain elusive.To compare the outcomes of technology-dependent infants discharged from NICU with tracheostomy following UC versus CC.A single site retrospective study evaluated forty-three (N=43) technology-dependent infants discharged from NICU with tracheostomy over 5½ years (2011-2017). CC provided 24-hour accessible healthcare-providers using an enhanced medical home. Mortality, total hospital admissions, 30-days readmission rate, time-to-mechanical ventilation liberation, and time-to-decannulation were compared between groups.CC group showed significantly lower mortality (3.4%) versus UC (35.7%), RR, 0.09 [95%CI, 0.12-0.75], P=0.025. CC reduced total hospital admissions to 78 per 100 child-years versus 162 for UC; RR, 0.48 [95% CI, 0.25-0.93], P=0.03. The 30-day readmission rate was 21% compared to 36% in UC; RR, 0.58 [95% CI, 0.21-1.58], P=0.29). In competing-risk regression analysis (treating death as a competing-risk), hazard of having mechanical ventilation removal in CC was two times higher than UC; SHR, 2.19 [95% CI, 0.70-6.84]. There was no difference in time-to-decannulation between groups; SHR, 1.09 [95% CI, 0.37-3.15].CC significantly decreased mortality, total number of hospital admissions and length of time-to-mechanical ventilation liberation.