A Sociodemographic Comparison of Families of Very Low-Birthweight Infants: 1982-1991

Abstract Social and demographic characteristics were investigated in families who had very low-birthweight infants between 1982 and 1984 (historical cohort). Since those data were collected, the number of women using drugs during pregnancy has increased significantly. Therefore, between 1989 and 1991 (current cohort) we continued to document sociodemographic characteristics of families of very low-birthweight infants (144 mothers, 156 infants). Data were collected from review of hospital charts and outpatient health records, and monthly interviews. The two cohorts were similar demographically. Changes in family composition occurred more frequently in the current cohort. There was a startling increase in illicit drug use between the two groups of women: 3% in the historic cohort and 20% in the current cohort. In the historical cohort all infants went home to their mothers; however, in the current cohort 7.8% of infants were placed with other family caretakers. Infant health outcomes for the first six month after hospital discharge were similar in both groups. From 1982 to 1991 the increases in substance abuse, nonmaternal caretakers, family moves, and changes in family composition have implications for health care providers involved in infant follow-up care.     

Early Discharge and Specialist Transitional Care

A model has been designed to discharge patients early from the hospital by substituting a portion of hospital care with a comprehensive program of transitional home follow-up by nurse specialists. The model, initially tested with very low birth weight infants, provides a framework for examining both the quality of care as reflected in patient outcomes and cost of care to specific patient groups. Its design documents nursing interventions and allows for comparisons of care by nurse specialists and other health care providers.     

What were the outcomes of home follow-up visits after postpartum hospital discharge?

OBJECTIVES: To assess health outcomes of home follow-up visits after postpartum discharge and assess relationships between the number of home visits and selected outcomes among women who gave birth at two Queensland, Australia, regional hospitals. DESIGN: A cross sectional study. Services provided during the home visits were responsive to a woman's need rather than having a structured protocol of services. MAIN OUTCOME MEASURES: The four measured health outcomes were: 1) postpartum depression; 2) confidence to undertake maternal roles; 3) breastfeeding; and, 4) satisfaction with postpartum care. RESULTS: Of 210 women who were invited to participate in the study, 143 (68.1%) provided information. Women who received a higher number of home visits had significantly lower confidence to undertake maternal roles than those who received fewer home visits. There was a positive correlation between the number of home follow-up visits and postpartum depression among women who gave birth at one hospital (Hospital B), but not at the other (Hospital A). No relationship was found between the home postpartum visits and the other outcomes. CONCLUSION: These results could be explained in that home follow-up visits were offered to all women at Hospital A while Hospital B only provided home visits to women who had a health risk due to their social, physical and psychological characteristics. The lack of protocol home visits and the characteristics of women receiving the visits were probably the major factors which influenced these limited beneficial outcomes.     

出院准备服务对早产儿家庭出院准备度及其生长发育的影响

目的 探讨出院准备服务对早产儿家庭出院准备度的影响,以促进早产儿生长发育、减少再入院率。方法 以2021年1-6月收治于复旦大学附属中山医院青浦分院新生儿重症监护室的40例早产儿及其主要照护者作为对照组,给予常规护理干预;以2021年7-12月收治的40例早产儿及其主要照护者作为观察组,采用“评估-指导-再评估-再指导”的院内外护理。比较出院时两组早产儿家庭的出院准备度评分,出院3个月后主要照顾者对延续护理的满意度,以及两组早产儿的再入院情况及身高、体质量的达标率。结果 出院时,观察组早产儿出院家庭准备度评分为（23.28±7.23）分,高于对照组（19.28±5.95）分（P<0.05）。出院3个月后,观察组照顾者对延续护理服务的满意度得分高于对照组（P<0.05）;观察组早产儿再入院率为0,低于对照组的7.5%(P<0.05),且观察组早产儿身高及体质量达标率均高于对照组（均P<0.05）。结论 出院准备服务可提高早产儿家庭出院准备度及照顾者对延续护理的满意度,有利于促进早产儿生长发育、降低其再入院率,有助于促进患儿健康及护理质量提升。     

Can home visits help reduce hospital readmissions? Randomized controlled trial

Title. Can home visits help reduce hospital readmissions? Randomized controlled trial Aim. This paper is a report of a study to determine whether home visits can reduce hospital readmissions. Background. The phenomenon of hospital readmission raises concerns about the quality of care and appropriate use of resources. Home visits after hospital discharge have been introduced to help reduce hospital readmission rates, but the results have not been conclusive. Method. A randomized controlled trial was carried out from 2003 to 2005 . The control group (n = 166) received routine care and the study group (n = 166) received home visits from community nurses within 30 days of hospital discharge. Data were collected at baseline before discharge and 30 days after discharge. Findings. Patients in the study group were statistically significantly more satisfied with their care. There were no statistically significant differences in other outcomes, including readmission rate, ADL score, self‐perceived life satisfaction and self‐perceived health. Regression analysis revealed that self‐perceived life satisfaction, self‐perceived health and disease category other than general symptoms were three statistically significant variables predicting hospital readmissions. Conclusion. Preventive home visits were not effective in reducing hospital readmissions, but satisfaction with care was enhanced. Subjective well‐being is a key variable that warrants attention in the planning and evaluation of postdischarge home care.     

Can municipality-based post-discharge follow-up visits including a general practitioner reduce early readmission among the fragile elderly (65+ years old)? A randomized controlled trial

Objective. To evaluate how municipality-based post-discharge follow-up visits including a general practitioner and municipal nurse affect early readmission among high-risk older people discharged from a hospital department of internal medicine. Design and setting. Centrally randomized single-centre pragmatic controlled trial comparing intervention and usual care with investigator-blinded outcome assessment. Intervention. The intervention was home visits with a general practitioner and municipal nurse within seven days of discharge focusing on medication, rehabilitation plan, functional level, and need for further health care initiatives. The visit was concluded by planning one or two further visits. Controls received standard health care services. Patients. People aged 65 + years discharged from Holbæk University Hospital, Denmark, in 2012 considered at high risk of readmission. Main outcome measures. The primary outcome was readmission within 30 days. Secondary outcomes at 30 and 180 days included readmission, primary health care, and municipal services. Outcomes were register-based and analysis used the intention-to-treat principle. Results. A total of 270 and 261 patients were randomized to intervention and control groups, respectively. The groups were similar in baseline characteristics. In all 149 planned discharge follow-up visits were carried out (55%). Within 30 days, 24% of the intervention group and 23% of the control group were readmitted (p = 0.93). No significant differences were found for any other secondary outcomes except that the intervention group received more municipal nursing services. Conclusion. This municipality-based follow-up intervention was only feasible in half the planned visits. The intervention as delivered had no effect on readmission or subsequent use of primary or secondary health care services.     

Factors associated with referral of elderly individuals with cardiac and pulmonary disorders for home care services following hospital discharge

Referrals for home care services initiated prior to hospital discharge may prevent or delay readmission or nursing home placement, especially for elderly individuals with multiple, chronic health problems. While multiple factors could justify the need for home follow-up after hospital discharge, little is known about those patient factors associated with clinicians' decisions to refer older adults with cardiac or pulmonary disorders. Increased understanding of factors that contribute to initiating a home care referral could enhance clinicians' decision-making and thus improve post-discharge outcomes for these patient groups. This study examined patient factors associated with and predictive of the decision to refer for home follow-up, using a sample of older adults hospitalized with chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). Study findings suggest a model that includes patients diagnosed with both COPD and CHF, who are not married, need home health aides, and have a longer than average length of hospital stay may be helpful in predicting the need for home care referrals.     

Investigating early readmission as an indicator for quality of care studies

Readmission to a hospital shortly following a previous discharge may be viewed as an adverse outcome of care. Consequently, early readmission represents a potentially useful indicator for monitoring quality. While a number of recent research studies have focused on this issue, several important questions concerning appropriate use of early readmission as a quality of care indicator remain to be addressed. In this article, using data on all discharges for 1 year from 18 hospitals, several of these questions are investigated. Specifically, whether the significant predictors of readmission risk are different for different types of cases (defined using DRGs), whether case severity is an important predictor of readmission risk, whether readmission risks differ systematically with hospital size and other characteristics, whether readmission risk is a function of patients' lengths-of-stay, and whether readmission risk is influenced by whether or not patients are discharged home or into organized care environments are explored. For this study, the focus is on patients who experienced unplanned readmissions to acute care hospitals within 31 days of a prior discharge. The Patient Management Category classification system and ICD-9-CM diagnosis and procedure codes are used to identify, and then exclude from consideration, those readmissions that occurred as part of an appropriately planned sequence of care. In each of 22 sets of related DRGs, analysis of unplanned readmissions indicates that severity/complexity is an important risk factor for early readmission and that clinical and other risk factors differ for different DRG groups. Thus, in future studies of early readmissions, researchers will need to control for both the type (e.g., DRG) and severity/complexity of individual cases. In examining relationships between early readmission and hospital characteristics, no consistent patterns suggestive of quality of care problems were detected.     

Neonatal jaundice. Strategies to reduce bilirubin-induced complications

Neonatal hyperbilirubinemia is the most common reason for hospital readmission in the first 2 weeks of life. Kernicterus is still relatively uncommon but has been on the rise with the institution in the 1990's of aggressive early postnatal discharge policies. Bilirubin-induced complications can be prevented by instituting a neonatal jaundice protocol to identify infants at risk for significant hyperbilirubinemia, by ensuring adequate parental education and preparedness, and by implementing a good neonatal tracking system for follow-up care. Hyperbilirubinemia is easily treated with phototherapy, which can be administered at home in selected infants.     

Discharge planning and follow-up care: the asphyxiated infant.

Discharge planning and follow-up care of the asphyxiated infant is a complex process. Models of discharge planning, team member responsibilities, and teaching responsibilities are components of hospital discharge plans. Special care needs of these infants may include vision, hearing, immunizations, seizures, medications, and feeding. Families and health care professionals need to be familiar with programs providing financial resources for care of the infant such as private insurance, prepaid health care, Medicaid, Medical Needy program, Children with Special Health Care Needs (CSHCN), federal legislation mandating education and services for high-risk infants (PL 99-142 and PL 99-457) and intervention programs. Families returning to Newborn Follow-up programs become acquainted with a variety of professionals and types of neonatal and infant assessments. Providing teaching materials and information regarding special health problems, services and outcome, as it becomes known, is the responsibility of the extended health care team of nurses, physicians, home health services, psychologists, and therapists.     

Health risks and psychosocial outcomes of early childbearing: a review of the literature

This article presents a review of the literature on the obstetric, medical, and neonatal health risks as well as psychosocial outcomes associated with early childbearing. An important concern in adolescent pregnancies is the increased risk for infant morbidity and mortality as a result of higher incidence of preterm births and low-birthweight infants. Implications for prenatal and postpartum nursing care are discussed. Promising new models to improve care of young mothers and their children, such as home visitation by public health nurses, are presented and features of successful intervention programs outlined.     

Who Is at Risk? High-Risk Infant Follow-up

Plans for discharge home from the neonatal intensive care unit (NICU) should begin with identification of which infants are at-risk for developing disability or early demise. As much as possible, this article serves as an evidenced-based review for identifying vulnerable infants in the NICU who are at higher risk for morbidity or early mortality. This article draws on the American Association of Pediatrics recommendations that highlight the responsibilities of the NICU team to recognize risk, plan discharge, and assist with transitioning care post discharge. Nurses, as professional team members, are ideal for identifying at-risk status, devising individualized discharge plans, and assuring referrals to high-risk infant follow-up (HRIF). HRIF programs bridge care pre and post NICU discharge to assure that infants with complex issues and special needs reach optimal health and developmental levels.     

Parenting the post-NICU premature infant

The birth of a premature infant is stressful for family members who must adjust to unfamiliar surroundings, learn new vocabularies, cope with the infant's uncertain survival and outcome, maintain vigilance at the neonatal intensive care unit (NICU), and eventually assume care for a recovering infant at home. Nursing research has focused on many issues related to parenting prematurely born infants, including parenting during the initial hospitalization, concerns of mothers about infant discharge, the relationship between premature infants and their mothers during the first 2 years after hospital discharge, the quality of the home environment on premature infant outcomes, parenting after the first 2 years, and interventions to improve parenting. This article focuses on research about parenting the post-NICU discharge infant to assist nurses in giving comprehensive, evidence-based care.     

Evaluation of an Interagency Home Visiting Program to Reduce Postneonatal Mortality in Disadvantaged Communities

Abstract This paper describes an interagency home visiting program, Resources, Education and Care in the Home (REACH), designed to reduce preventable causes of morbidity among normal, socioeconomically disadvantaged infants at risk for adverse outcomes due to social factors. Home nursing visits by a trained nurse-community worker team were made throughout the first year of life to 1,269 infants from predominantly African American families. Results demonstrate that repeated home visits with ongoing infant health monitoring plus individualized and culturally sensitive teaching helped mothers maintain good health practices and identify illnesses early. Infants' outcomes during the neonatal period and at 12 months showed consistent, though statistically nonsignificant, positive effects on physical health. The postneonatal mortality rate among REACH infants was 4.7 deaths per 1000 live births in communities where rates for nonpar ticipants ranged from 5.2 to 10.9 per 100. The evaluation demonstrates a need in this population for more intensive services with greater continuity of care. Specific areas where more education is needed include home safety, skin care, and early identification and treatment of upper respiratory infections. Infants from communities with high infant mortality rates present numerous preventable morbidities requiring interventions, even when they are not considered medically high-risk at birth.     

Costs of postpartum care: examining associations from the Ontario mother and infant survey.

A cross-sectional survey of 1,250 mothers of "normal" newborn infants was conducted to assess mother and infant characteristics as well as the costs of health and social services used in the first 4 weeks after discharge from hospital in the province of Ontario, Canada. Each mother was asked to recall use of services for herself and her infant. This utilization was multiplied by the unit cost of each service and summed to arrive at the total cost of services used. Although re-admission rates were low (1% for mothers, 4% for infants), costs associated with hospital and emergency room care ($194 on average per mother/infant dyad) accounted for the greatest proportion of total health-care costs. Physician or midwife visits, which were received by almost all mothers, were the next most costly service ($128 on average per dyad). Mothers with incomes under $20,000 had more medical costs than those with higher incomes. Costs of community nursing care ($86 on average per dyad) were higher for mothers with more than 5 self-identified learning needs (e.g., infant feeding, infant care and behaviour, emotional changes in self, signs of illness in infant); perception of their own health as poor; perception of inadequate help and support at home; many signs and symptoms of depression; and postpartum hospital stay of 48 hours or less. Costs for social work visits were higher for mothers with depression and mothers with low incomes. Total health and social service costs were double for mothers with family incomes under $20,000 ($788 vs. $399 on average per dyad) and for mothers with clinical depression ($845 vs. $413). Specifically, nursing care costs were greater for mothers with high depression scores ($135 vs. $81).     

Effect of postnatal home visits on maternal/infant outcomes in Syria: a randomized controlled trial

OBJECTIVE: Early postpartum home visiting is universal in many Western countries. Studies from developing countries on the effects of home visits are rare. In Syria, where the postpartum period is rather ignored, this study aimed to assess whether a community-based intervention of postnatal home visits has an effect on maternal postpartum morbidities; infant morbidity; uptake of postpartum care; use of contraceptive methods; and on selected neonatal health practices. DESIGN: A randomized controlled trial was carried out in Damascus. Three groups of new mothers were randomly allocated to receive either 4 postnatal home visits (A), one visit (B), or no visit (C). SAMPLE: A total of 876 women were allocated and followed up. INTERVENTION: Registered midwives with special training made a one or a series of home visits providing information, educating, and supporting women. RESULTS: A significantly higher proportion of mothers in Groups A and B reported exclusively breastfeeding their infants (28.5% and 30%, respectively) as compared with Group C (20%), who received no visits. There were no reported differences between groups in other outcomes. CONCLUSIONS: While postpartum home visits significantly increased exclusive breastfeeding, other outcomes did not change. Further studies framed in a nonbiomedical context are needed. Other innovative approaches to improve postnatal care in Syria are needed.     

Risks for unplanned hospital readmission in a teaching hospital in southern Taiwan

The purpose of this study was to assess and analyse hospital readmission and its risk factors for patients who were visited by a discharge planning coordinator during hospitalization in a teaching hospital located in southern Taiwan. Results found that 67 patients (5.7%) were readmitted within 14 days of discharge during the data collection period. Twenty-eight patients (41.8%) were readmitted because of complications. Patients' previous diagnoses and complications were two major reasons for patients to be re-hospitalized within 14 days of discharge. In addition, significant predictors for unplanned hospital readmission within 14 days of discharge were patients who received care from home health care nurses or hospice home health care nurses.     

Effectiveness of the PRECEDE-PROCEED model for improving the care knowledge,skill, and sense of competence in mothers of preterm infants

ObjectiveThis quasi-randomized controlled trial was performed to evaluate the effects of the PRECEDE-PROCEED model (PPM) in enabling mothers of preterm infants to develop care knowledge, skill, and a sense of competence.MethodsAmong 116 mothers of preterm infants, 60 received traditional discharge education (control group) and 56 received PPM discharge education (PPM group). Improvement in knowledge and skills was transformed into the mothers’ routine daily care of infants. The primary outcome was knowledge of preterm infant care. The secondary outcomes were preterm infant care skills and a sense of competence, routine intervention compliance among mothers, and the readmission rate of infants 6 months after discharge.ResultsSix months after discharge, the mean knowledge score and mean skills score were significantly higher in the PPM group than in the control group. The mothers’ sense of competence with respect to both self-efficacy and satisfaction was also significantly better in the PPM group than in the control group. Moreover, intervention behavior compliance and the readmission rate were significantly better in the PPM group than in the control group.ConclusionCare knowledge, skills, and sense of competence in mothers of preterm infants improved after implementation of the PPM.     

Homeward bound: An analysis of patients discharged home from an oncologic intensive care unit

Purpose

The objectives of our study were to evaluate the characteristics and outcomes of patients discharged home directly from an oncologic intensive care unit (ICU) and their 30-day hospital readmission patterns.

Materials and Methods

We retrospectively reviewed ICU discharges over 3 years (2008-2010) and identified patients who were discharged directly home. Demographic, clinical, ICU discharge, and 30-day hospital readmission and mortality rates were analyzed.

Results

Ninety-five patients (3.6%) were discharged home directly from the ICU (average annual rate of 3.9%). ICU diagnoses primarily included respiratory insufficiency, sepsis, cardiac syndromes, and gastrointestinal bleeding. Home discharge occurred most commonly between Thursday and Saturday. Five (5.3%) patients, including 2 hospice patients, died within 30 days of ICU home discharge. Thirty (31.6%) patients were readmitted within 30 days of discharge. The unplanned 30-day readmission rate was 23.2% (22/95) with a median time to hospital readmission of 13 (8-18) days. Most (64%) of the unplanned readmissions were related to the initial ICU admission.

Conclusions

Home discharge of ICU patients at our institution is infrequent but consistent. Almost one third of these patients were readmitted to the hospital within 30 days. Enhancements to the ICU home discharge process may be required to ensure optimal post-ICU care.