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Reduced Healthcare Utilization At 6-Weeks Corrected Age Among Premature Infants After the H-HOPE Mother-Infant Developmental Intervention

Monday, June 17, 2013 : 10:30 AM

Title: Reduced Healthcare Utilization At 6-Weeks Corrected Age Among Premature Infants After the H-HOPE Mother-Infant Developmental Intervention

Cheekwood ABC (Gaylord Opryland)
Rosemary White-Traut, PhD, RN, FAAN , UIC College of Nursing, Chicago, IL

Discipline: Advanced Practice (AP), Newborn Care (N)

Learning Objectives:
  1. Review early in hospital and at home interventions that support mothers and their premature infants.
  2. Discuss the infant remediation and maternal re-education and redefinition components of the Integrated H-HOPE Intervention and the rational for incorporating these interventions into an integrated approach.
  3. Compare differences in health care utilization following the H-HOPE Intervention; and, identify factors that contribute to patterns of health care utilization for newly discharged premature infants.
Submission Description:
Objective:  To examine whether an integrated developmental intervention for mothers and their premature infants results in lower levels of health care utilization (HCU) between hospital discharge and 6-weeks corrected age (CA).

Design: Prospective randomized clinical trial.

Setting: Two community hospital neonatal intensive care units.

Sample: Sample included (N=145) otherwise healthy infants, 29-34 weeks gestational age at birth, whose mothers reported at least 2 of 10 social-environmental risk factors, e.g., poverty, minority status.

Methods: This randomized trial tested the Impacts of Hospital-Home Transition: Optimizing Prematures' Environment (H-HOPE).  The intervention included: (1) infant remediation using a multisensory approach; and (2) maternal redefinition and re-education, using maternal participatory guidance.  Maternal report of infant HCU after hospital discharge is measured at 6-weeks corrected age (CA).  T-tests and multivariable log-binomial regression models (alpha = 0.05) were used to estimate the effect of the intervention on HCU.

Results:  At six-weeks CA, H-HOPE infants had a significantly lower number of health care visits than control infants (H-HOPE mean = 3.3, SD = 1.42, n = 68 vs. Control mean = 3.8, SD = 1.41, n = 77).  H-HOPE infants were significantly less likely to have visited a provider for an illness than control infants (30.9% vs. 46.8%, respectively).  After controlling for maternal and infant factors, mothers in the H-HOPE group were 35% less likely to have taken their infant to one or more acute care visits by 6 weeks corrected age compared to control group mothers (adjusted Prevalence Ratio = 0.65, 95% CI = 0.43 - 0.98, p=0.04). 

Conclusion/Implications for nursing practice: H-HOPE infants were less likely to see a provider for an illness between hospital discharge and six-weeks CA.  Costs of care for subsequent illness among preterm infants may be reduced as a result. 

Keywords:  premature infants, hospitalization, costs