Comprehensive follow-up care and life-threatening illnesses among high-risk infants: A randomized controlled trial

JAMA. 2000 Oct 25;284(16):2070-6. doi: 10.1001/jama.284.16.2070.


Context: Inner-city high-risk infants often receive limited and fragmented care, a problem that may increase serious illness.

Objective: To assess whether access to comprehensive care in a follow-up clinic is cost-effective in reducing life-threatening illnesses among high-risk, inner-city infants.

Design: Randomized controlled trial.

Setting and participants: A total of 887 very-low-birth-weight infants born in a Texas county hospital between January 1988 and March 1996 and followed up in a children's hospital clinic. One hundred four infants who became ineligible or died after randomization but before nursery discharge were excluded from the analysis.

Interventions: Infants were randomly assigned to receive routine follow-up care (well-baby care and care for chronic illnesses; n = 441) or comprehensive care (which included the components of routine care plus care for acute illnesses, with 24-hour access to a primary caregiver; n = 446).

Main outcome measures: Life-threatening illnesses (ie, causing death or hospital admission for pediatric intensive care) occurring between nursery discharge and age 1 year, assessed by blinded evaluators from inpatient charts and state Medicaid and vital statistics records; and hospital costs (estimated from department-specific cost-to-charge ratios).

Results: Comprehensive care resulted in a mean of 3.1 more clinic visits and 6.7 more telephone conversations with clinic staff (P<.001 for both). One-year outcomes were unknown for fewer comprehensive-care infants than routine-care infants (9 vs 28; P =.001). Identified deaths were similar (11 in comprehensive care vs 13 in routine care; P =.68). The comprehensive-care group had 48% fewer life-threatening illnesses (33 vs 63; P<.001), 57% fewer intensive care admissions (23 vs 53; P =.003), and 42% fewer intensive care days (254 vs 440; P =.003). Comprehensive care did not increase the mean estimated cost per infant for all care ($6265 with comprehensive care and $9913 with routine care).

Conclusion: Comprehensive follow-up care by experienced caregivers can be highly effective in reducing life-threatening illness without increasing costs among high-risk inner-city infants. JAMA. 2000;284:2070-2076.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Chronic Disease
  • Comprehensive Health Care / economics
  • Comprehensive Health Care / organization & administration*
  • Continuity of Patient Care / organization & administration*
  • Cost-Benefit Analysis
  • Critical Illness
  • Health Services Accessibility / organization & administration*
  • Health Services Research
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Infant Care / economics
  • Infant Care / organization & administration*
  • Infant, Newborn
  • Infant, Newborn, Diseases / prevention & control*
  • Outpatient Clinics, Hospital / economics
  • Outpatient Clinics, Hospital / organization & administration*
  • Risk Factors
  • Texas
  • United States
  • Urban Population