Development of a Multidisciplinary Medical Home Program for NICU Graduates

Feehan, Katie; Kehinde, Folasade; Sachs, Katherine; Mossabeb, Roschanak; Berhane, Zek; Pachter, Lee M.; Brody, Susan; Turchi, Renee M.

doi:10.1007/s10995-019-02818-0

Cited by 18 publications

(17 citation statements)

References 17 publications

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“…Many current reservations about bridled NGTs may be overcome with approaches that are gaining momentum, such as telemedicine platforms to link patients with specialty services or offering expanded types of support within established NICU follow-up programs or medical homes. 18,19 Provider training, revision of patient education materials, and creation of tools in the electronic health record such as order bundles and smart phrases are foundations to which NICUs contemplating implementation of a bridle program may wish to first consider.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Neonatal Intensive Care Unit Graduates with Bridled Nasogastric Feeding Tubes

et al. 2022

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Objective The aim of this study was to describe clinical outcomes of bridled nasogastric tube (NGT) program implementation for infants requiring assisted home feeding (AHF) to discharge from the neonatal intensive care unit (NICU). Study Design This was a descriptive prospective analysis of a pilot cohort of infants after implementation of a bridled NGT AHF program to facilitate discharge from level III and IV NICUs from March 2019 to October 2020. Results Of 29 attempts in infants, 22 infants were discharged with bridled NGTs over 18 months. Bridle placement was unsuccessful in three patients, and four bridles were removed before discharge. Bridle use ranged from 7 to 125 days, with a median duration of 37 days. Dislodgement rate was 0.69 per 100 days. Seventeen infants (77%) achieved full oral feeds, while five (23%) discharged with bridled NGTs later converted to gastrostomy tubes. Conclusion Implementation of a bridled NGT program is feasible for level III and IV NICUs to facilitate discharging infants who require feeding support to transition home. Key Points

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Neonatal Intensive Care Unit Graduates with Bridled Nasogastric Feeding Tubes

et al. 2022

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“…Care coordinators had access to and knowledge of institutional and community resources (ie, transportation and parking vouchers, WIC services (Special While care coordination programs have been previously described for infants with medical complexity, most of that research focused on inpatient and outpatient care coordination as disparate entities. 5,[12][13][14][15][16][17] Existing research has identified a need for systems that address the evolving psychosocial needs of NICU parents beyond discha rge. 15,19,25,26 Purdy et al 18 recommended 4 characteristics to consider: emotional support, parenting education, medical follow-up care, and home visitations.…”

Section: Discussionmentioning

confidence: 99%

“…While care coordination programs have been previously described for infants with medical complexity, most of that research focused on inpatient and outpatient care coordination as disparate entities 5,12–17. Existing research has identified a need for systems that address the evolving psychosocial needs of NICU parents beyond discharge 15,19,25,26.…”

Section: Discussionmentioning

confidence: 99%

“…11 Due to the dearth of existing research in this area, it was necessary to include articles published greater than 5 years ago. While existing research has identified a need for parental support during NICU admission, 5,12 surrounding discharge, 13,14 and postdischarge, [15][16][17] these are largely studied as independent periods. Although longitudinal support has been identified as a need, 18 limited evidence exists to support a longitudinal care coordination model that spans NICU admission, discharge, and outpatient care.…”

Section: Literature Reviewmentioning

confidence: 99%

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Family and Provider Experiences With Longitudinal Care Coordination for Infants With Medical Complexity

Dallas

Ryan

Mestan

et al. 2022

Advances in Neonatal Care

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Background: Parents in the neonatal intensive care unit (NICU) report low self-confidence managing their children's ongoing medical and social needs. While bedside nurses provide critical support for families throughout their NICU admission, there may be a role for nursing coordination throughout hospitalization, discharge, and in the transition to outpatient care. Purpose: This program evaluation explores parent and provider experiences of a novel longitudinal care coordination program for infants with medical complexity from the NICU through their first year of life post-discharge. Methods: First, a sequential exploratory mixed-methods approach was used to evaluate parental experiences (n = 5 interviewed followed by n = 23 surveyed). Provider perspectives were elicited through semi-structured interviews (n = 8) and focus groups (n = 26 in 3 groups). Results: Parent-reported benefits included frequent communication and personalized support that met families' and patients' evolving needs. Care coordinators, who were trained as nurses and social workers, developed longitudinal relationships with parents. This seemed to facilitate individualized support throughout the first year of life. Providers reported that smaller caseloads were central to the success of the program. Implications for Practice and Research: This longitudinal care coordination program can be used as a translatable model in NICUs elsewhere to address the unique needs of families of infants with medical complexity throughout the first year of life. Future implementations should consider how to expand program size while maintaining individualized supports. As the care coordinators are former NICU nurses and social workers, there may be a growing role for nursing coordination of care in the neonatal population.

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“…Access to care 30 44,[48][49][50][51][52][53][54][55][57][58][59][60]62,63,65,[72][73][74]83,86,88,89,91,93,95,96,98,100,101,103 Using technology to connect families to providers 12 Improving availability of and access to medications 6 57,62,73,74,88,93,96 Medication supply to rural posts (connected via telemedicine) Dispense medications at discharge Access to an online platform for treatment and support 4 [49][50][51]63 Websites or mobile applications to answer caregiver questions Care coordination 28 44,48,[50][51][52][53]…”

Section: Approaches Number Of Interventions Implementation Examplesmentioning

confidence: 99%

Family‐centred care interventions for children with chronic conditions: A scoping review

Chow,

Saad,

Al‐Baldawi

et al. 2024

Health Expectations

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IntroductionChildren with chronic conditions have greater health care needs than the general paediatric population but may not receive care that centres their needs and preferences as identified by their families. Clinicians and researchers are interested in developing interventions to improve family‐centred care need information about the characteristics of existing interventions, their development and the domains of family‐centred care that they address. We conducted a scoping review that aimed to identify and characterize recent family‐centred interventions designed to improve experiences with care for children with chronic conditions.MethodsWe searched Medline, Embase, PsycInfo and Cochrane databases, and grey literature sources for relevant articles or documents published between 1 January 2019 and 11 August 2020 (databases) or 7–20 October 2020 (grey literature). Primary studies with ≥10 participants, clinical practice guidelines and theoretical articles describing family‐centred interventions that aimed to improve experiences with care for children with chronic conditions were eligible. Following citation and full‐text screening by two reviewers working independently, we charted data covering study characteristics and interventions from eligible reports and synthesized interventions by domains of family‐centred care.ResultsOur search identified 2882 citations, from which 63 articles describing 61 unique interventions met the eligibility criteria and were included in this review. The most common study designs were quasiexperimental studies (n = 18), randomized controlled trials (n = 11) and qualitative and mixed‐methods studies (n = 9 each). The most frequently addressed domains of family‐centred care were communication and information provision (n = 45), family involvement in care (n = 37) and access to care (n = 30).ConclusionThis review, which identified 61 unique interventions aimed at improving family‐centred care for children with chronic conditions across a range of settings, is a concrete resource for researchers, health care providers and administrators interested in improving care for this high‐needs population.Patient or Public ContributionThis study was co‐developed with three patient partner co‐investigators, all of whom are individuals with lived experiences of rare chronic diseases as parents and/or patients and have prior experience in patient engagement in research (I. J., N. P., M. S.). These patient partner co‐investigators contributed to this study at all stages, from conceptualization to dissemination.

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Development of a Multidisciplinary Medical Home Program for NICU Graduates

Cited by 18 publications

References 17 publications

Clinical Outcomes of Neonatal Intensive Care Unit Graduates with Bridled Nasogastric Feeding Tubes

Clinical Outcomes of Neonatal Intensive Care Unit Graduates with Bridled Nasogastric Feeding Tubes

Family and Provider Experiences With Longitudinal Care Coordination for Infants With Medical Complexity

Family‐centred care interventions for children with chronic conditions: A scoping review

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