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



Wilfredo De Jesus-Rojas1, *, Ricardo A. Mosquera1, Cheryl Samuels2, Julie Eapen2, Traci Gonzales2, Tomika Harris2, Sandra McKay2, Fatima Boricha2, Claudia Pedroza1, Chiamaka Aneji3, Amir Khan3, Cindy Jon1, Katrina McBeth1, James Stark1, Aravind Yadav1, Jon E. Tyson3
1 Division of Pulmonary Medicine/Allergy & Immunology/Rheumatology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas
2 High-Risk Children’s Clinic, McGovern Medical School, University of Texas Health Science Center, Houston, Texas
3 Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas

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 5-½ 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: Decannulation, Tracheostomy, Complex-care, Mortality, Comprehensive-care, Usual-care.


Abstract Information


Identifiers and Pagination:

Year: 2018
Volume: 12
Publisher Item Identifier: EA-TORMJ-2018-8

Article History:

Received Date: 29/3/2018
Revision Received Date: 6/5/2018
Acceptance Date: 21/6/2018
Electronic publication date: 9/7/2018
Collection year: 2018

© 2018 De Jesus-Rojas et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Correspondence: Address correspondence to this author at the Division of Pulmonary Medicine/Allergy & Immunology/Rheumatology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin Street, MSB 3.228 Houston, Texas 77030; E-mail: Wilfredo.DeJesusRojas@uth.tmc.edu