Bernardo Janine P, Yanek Lisa, Donohue Pamela
Division of Neonatology, Department of Pediatrics, Massachusetts General Hospital, Boston, MA 02114, USA.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Children (Basel). 2024 May 4;11(5):550. doi: 10.3390/children11050550.
Outpatient care following discharge from a neonatal intensive care unit (NICU) is critical for streamlined transfer of care. Yet, information is lacking about the characteristics of early outpatient care. The objective of this secondary data analysis is to describe outpatient encounters (OPEs) within the first three months following the discharge of commercially insured infants admitted to NICUs in the MarketScan Research Database nationally from 2015 to 2017. Data were analyzed using descriptive statistics and logistic regression. A total of 22,214 NICU survivors were included, of whom half had an OPE within two days following discharge (quartiles 1, 3) and 90% within five days. The median number of OPEs in the first three months was five (quartiles 4, 7). A majority of first physician visits were with pediatricians (81.5%). A minority of infants with chronic conditions saw subspecialists. Term infants with delayed care had a lower risk of readmission. Spending was higher for preterm infants and those with chronic conditions. We conclude that most patients are seen shortly after discharge and by pediatricians; however, there is room for improvement. Frequent encounters and spending afflict high-risk groups with chronic conditions. Future work should examine the associations of early outpatient care with social determinants of health and other outcomes such as immunizations.
新生儿重症监护病房（NICU）出院后的门诊护理对于简化护理转接至关重要。然而，关于早期门诊护理的特征信息却很缺乏。这项二次数据分析的目的是描述2015年至2017年全国范围内在MarketScan研究数据库中入住NICU的商业保险婴儿出院后头三个月内的门诊就诊情况（OPEs）。使用描述性统计和逻辑回归对数据进行分析。总共纳入了22214名NICU幸存者，其中一半在出院后两天内进行了门诊就诊（四分位数1、3），90%在五天内就诊。头三个月门诊就诊的中位数为五次（四分位数4、7）。大多数首次就诊的医生是儿科医生（81.5%）。少数患有慢性病的婴儿看了专科医生。足月但护理延迟的婴儿再次入院风险较低。早产儿和患有慢性病的婴儿花费更高。我们得出结论，大多数患者在出院后不久就就诊且看的是儿科医生；然而，仍有改进空间。频繁就诊和高花费困扰着患有慢性病的高危群体。未来的工作应研究早期门诊护理与健康的社会决定因素以及其他结果（如免疫接种）之间的关联。
