title: Improving health care usage in a very low birth weight population.
abstract: BACKGROUND
  Prematurity is the biggest contributor to admissions in the neonatal intensive care unit (NICU). The period following hospital discharge is a vital continuum for the very low birth weight (VLBW) infant. The objective of this study was to assess the impact of a unique discharge and follow-up process on the outcomes of VLBW infants leaving the NICU.
  
  
  METHODS
  All outpatient health care usage by VLBW infants born in the study year (cases) was retrospectively tracked through 12 months of age. A cohort of healthy newborn infants were matched by birthdate to each VLBW infant (controls) and similarly tracked.
  
  
  RESULTS
  In this study, there were 85 cases and 85 controls. The mean gestational age at birth for the cases was 29.1 ± 2.7 weeks with a mean birth weight of 1079 ± 263 g. That of the controls was 38.9 ± 1.3 weeks and 3202 ± 447 g. Over 90% of both populations had Medicaid coverage. All VLBW infants received care at the Special Care Developmental Follow-Up Clinic. When compared with the controls, VLBW infants discharged from the NICU made fewer acute, unscheduled visits to the Emergency Department or Urgent Care Clinic (2.3 ± 2.5 vs. 3.7 ± 3.5; P=0.007) despite their high-risk medical and social status. Their growth pattern showed significant "catch-up" and was similar to the matched controls at the last scheduled visit for each group.
  
  
  CONCLUSIONS
  Outcomes including health care utilization in high-risk infants can be improved through meticulous discharge planning and follow-up measures that utilize existing hospital infrastructure to provide affordable comprehensive care.
authors: Department of Pediatrics, Division of Neonatology, Case Western Reserve, Metrohealth Medical Center, 2500 Metrohealth Drive, Cleveland, OH, 44109, USA, wwambui@msn.com.
authors: Wambui
authors: W
authors: Waruingi
authors: Sai
authors: S
authors: Iyer
authors: Marc
authors: M
authors: Collin
mesh_terms: D016022:Case-Control Studies; D002662:Child Health Services / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D014481:United States