title: Care Coordination Associated with Improved Timing of Newborn Primary Care Visits.
abstract: Objective Despite practice recommendations that all newborns be examined within 3-5 days after discharge, many are not seen within this timeframe. Our objective was to determine the association between care coordination and timing of newborn follow-up. Methods This retrospective study evaluated 6251 newborns from eight maternity hospitals who scheduled a primary care appointment at one of two academic pediatric practices over 3.5 years. Two programs were sequentially implemented: (1) newborn discharge coordination, and (2) primary care intake coordination. Primary outcome was days between discharge and follow-up, dichotomized as ≤ or >5 days. Number of rescheduled appointments and loss to follow-up were also assessed. Adjusted relative risks (RR) and odds ratios (OR) were determined by piecewise generalized linear and logistic regression. Results Among 5943 newborns with a completed visit, 52.9 % were seen within 5 days of discharge (mean 6.7 days). After multivariable adjustment, the pre-exposure period (8 months) demonstrated a downward monthly trend in completing early follow-up (RR 0.93, p < 0.001). After initial program implementation, we observed a 3 % monthly increase (RR 1.03, p < 0.001 for test of slope change from pre-exposure to post-exposure), such that likelihood of recommended follow-up increased by roughly 72 % after discharge coordinator implementation and roughly 33 % after primary care coordinator implementation. The latter was also associated with a 13 % monthly decrease in odds of loss to follow-up (OR 0.87, p < 0.001). Conclusions for Practice Care coordination increases adherence among low income families to recommended newborn follow-up after birth hospitalization.
authors.affiliation: Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. ML# 7009, Cincinnati, OH, USA. neera.goyal@cchmc.org.|Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. neera.goyal@cchmc.org.|Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. neera.goyal@cchmc.org.|Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. ML# 7009, Cincinnati, OH, 45229, USA. neera.goyal@cchmc.org.
authors.forename: Neera K
authors.initials: NK
authors.lastname: Goyal
authors.affiliation: Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.|Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Hall
authors.affiliation: Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.|Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kahn
authors.affiliation: Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. ML# 7009, Cincinnati, OH, USA.|Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Wexelblatt
authors.affiliation: Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. ML# 7009, Cincinnati, OH, USA.|Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Greenberg
authors.affiliation: Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.|Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Zeina M
authors.initials: ZM
authors.lastname: Samaan
authors.affiliation: Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.|Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Courtney M
authors.initials: CM
authors.lastname: Brown
mesh_terms: D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D059012:Lost to Follow-Up; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data*; D010351:Patient Discharge; D010372:Pediatrics / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D013995:Time
keywords: Care coordination; Hospital discharge; Low socioeconomic status; Newborn; Primary care