Health Care Use Outcomes of an Integrated Hospital-to-Home Mother-Preterm Infant Intervention

Abstract

Objective: To compare health care use from initial hospital discharge through 6 weeks corrected age in two groups of mother-preterm infant dyads: those who received an intervention, Hospital to Home: Optimizing Premature Infant's Environment (H-HOPE), and an attention control group.

Design: Prospective randomized controlled trial.

Setting: Two community hospital NICUs.

Participants: Mothers (n = 147) with social-environmental risk factors and their stable preterm infants.

Methods: Mother-infant dyads were randomly assigned to the H-HOPE or control group. When infants reached 6 weeks corrected age, information about health care visits since their hospital discharges was collected through an interview.

Results: Only half of all infants received all recommended well-child visits. Infants in H-HOPE were half as likely to have acute care episodes (illness visit to the clinic or emergency department or hospital readmission) as control infants (odds ratio [OR] = 0.46, 95% confidence interval [CI] [0.22, 0.95]). Infants of mothers with high trait anxiety were nearly 3 times more likely to have an acute care episode (OR = 2.78, 95% CI [1.05, 7.26]), and mothers who had low education levels (OR = .22, 95% CI [0.08, 0.60]) were less likely to have acute care episodes. There was a trend toward fewer acute care visits for infants whose mothers preferred an English interview (OR = .47, 95% CI [0.21, 1.06]).

Conclusion: Findings emphasize the importance of reinforcing well-child visits for vulnerable preterm infants. H-HOPE, an integrated mother-infant intervention, reduces acute care episodes (visits to the clinic or emergency department or hospital readmissions) for preterm infants.

Keywords: RCT; health care use; illness rates; multisensory developmental intervention; preterm infant.