The Effect of Comprehensive Medical Care on the Long-Term Outcomes of Children Discharged from the NICU with Tracheostomy
| Autor: | Cindy Jon, Wilfredo De Jesus-Rojas, Claudia Pedroza, K. McBeth, Tomika S. Harris, Traci Gonzales, Fatima Boricha, Chiamaka Aneji, Aravind Yadav, J. Eapen, Cheryl L. Samuels, Jon E. Tyson, Amir M. Khan, Sandra McKay, Ricardo A. Mosquera, James M. Stark |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Pulmonary and Respiratory Medicine
Medical home medicine.medical_specialty medicine.medical_treatment Complex-care Population Medical care Usual-care 03 medical and health sciences 0302 clinical medicine Tracheostomy Decannulation 030225 pediatrics Internal medicine medicine Long term outcomes 030212 general & internal medicine Mortality education Respiratory Medicine Comprehensive-care Mechanical ventilation education.field_of_study business.industry Retrospective cohort study Usual care Breathing business |
| Zdroj: | The Open Respiratory Medicine Journal |
| ISSN: | 1874-3064 2011-2017 |
| Popis: | Background: 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. Objective: To compare the outcomes of technology-dependent infants discharged from NICU with tracheostomy following UC versus CC. Methods: 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. Results: 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]. Conclusion: CC significantly decreased mortality, total number of hospital admissions and length of time-to-mechanical ventilation liberation. |
| Databáze: | OpenAIRE |
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