Follow-up care for infants with chronic lung disease: a randomized comparison of community- and center-based models.
OBJECTIVE
Premature infants with chronic lung disease benefit from comprehensive care, which typically is based in tertiary medical centers. When such centers are not easily accessible, alternative models of care are needed. The purpose of this work was to compare community-based follow-up, provided via telephone contacts, to traditional center-based follow-up of premature infants with chronic lung disease.


METHODS
After discharge from neonatal intensive care, 150 premature infants with chronic lung disease were randomly assigned to either community-based (n = 75) or center-based (n = 75) follow-up. In community-based follow-up, a nurse specialist maintained telephone contact with the infant's primary caregiver and health care providers. Center-based follow-up consisted of visits to a medical center-based multidisciplinary clinic staffed by a neonatologist, a nurse specialist, and a social worker. The outcomes of interest were Bayley Scales of Infant Development mental developmental index and psychomotor developmental index, Vineland Adaptive Behavioral Composite, and growth delay (weight for length <5th percentile) at 1-year adjusted age and respiratory rehospitalizations through 1-year adjusted age.


RESULTS
In each randomization group, 73 infants survived, and 69 were evaluated at 1-year adjusted age. The median mental development index (corrected for gestational age) was 90 for both groups. The median psychomotor developmental index was 82 for the center-based group and 81 for the community-based group. The median Vineland Adaptive Behavioral Composite was 100 and 102 for the center-based and community-based groups, respectively. In the center-based and community-based groups, respectively, the proportions with growth delay were 13% and 26%, and the proportions rehospitalized for respiratory illness were 33% and 29%.


CONCLUSIONS
Infants randomly assigned to community-based, as compared with those randomly assigned to center-based follow-up, had similar developmental and health outcomes. The former approach might be a preferred alternative for families in rural settings or families for whom access to a tertiary care medical center is difficult.
O'Shea
T Michael
TM
Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. moshea@wfubmc.edu
Nageswaran
Savithri
S
Hiatt
Debbie C
DC
Legault
Claudine
C
Moore
Mary Lou
ML
Naughton
Michelle
M
Goldstein
Donald J
DJ
Dillard
Robert G
RG
D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002657:Child Development / Q000502:physiology; D002662:Child Health Services / Q000458:organization & administration*; D003191:Comprehensive Health Care; D016001:Confidence Intervals; D003266:Continuity of Patient Care / Q000592:standards* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000458:organization & administration; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D020380:Needs Assessment; D009657:North Carolina; D016017:Odds Ratio; D010351:Patient Discharge; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D011787:Quality of Health Care; D016019:Survival Analysis; D014481:United States