Impact of a Transition Home Program on Rehospitalization Rates of Preterm Infants.
To evaluate the effects of a transition home program on 90-day rehospitalization rates of preterm (PT) infants born at <37 weeks gestational age implemented over 3 years for infants with Medicaid and private insurance, and to identify the impact of social/environmental and medical risk factors on rehospitalization.



In this prospective cohort study of 954 early, moderate, and late PT infants, all families received comprehensive transition home services provided by social workers and family resource specialists (trained peers) working with the medical team. Rehospitalization data were obtained from a statewide database and parent reports. Group comparisons were made by insurance type. Regression models were run to identify factors associated with rehospitalization and duration of rehospitalization.



In bivariable analyses, Medicaid was associated with more infants hospitalized, more than 1 hospitalization, and more days of hospitalization. Early PT infants had more rehospitalizations by 90 days than moderate (P = .05) or late PT infants (P = .01). In regression modeling, year 3 of the transition home program vs year 1 was associated with a lower risk for rehospitalization by 90 days (OR, 0.57; 95% CI, 0.36-0.93; P = .03). Medicaid (P = .04), non-English-speaking (P = .02), multiple pregnancies (P = .05), and bronchopulmonary dysplasia (P = .001) were associated with increased risk. Both bronchopulmonary dysplasia and Medicaid were associated with increased days of rehospitalization in adjusted analyses. The major cause of rehospitalization was respiratory illness (61%).



Transition home prevention strategies must be directed at both social/environmental and medical risk factors to decrease the risk of rehospitalization.
Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI. Electronic address: bvohr@wihri.org.
Betty
B
Vohr
Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI.
Elisabeth
E
McGowan
Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI.
Lenore
L
Keszler
Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI.
Barbara
B
Alksninis
Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI.
Melissa
M
O'Donnell
Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI; College of Nursing, University of Rhode Island, Kingston, RI.
Katheleen
K
Hawes
Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI.
Richard
R
Tucker
D015331:Cohort Studies; D003266:Continuity of Patient Care; D005260:Female; D005865:Gestational Age; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000191:economics*; D020380:Needs Assessment; D010351:Patient Discharge; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D000069341:Transitional Care; D014481:United States
environmental risk; health insurance; peer counselors; social risk