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Open Respir Med J. 2018 Jul 31;12:39-49. doi: 10.2174/1874306401812010039. eCollection 2018.

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

Author information

1
Division of Pulmonary Medicine/Allergy & Immunology/Rheumatology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA.
2
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA.

Abstract

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.

KEYWORDS:

Complex-care; Comprehensive-care; Decannulation; Mortality; Tracheostomy; Usual-care

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