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Care Coordination Associated with Improved Timing of Newborn Primary Care Visits

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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.

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Acknowledgments

We acknowledge the contribution of Dr. Andrew Beck MD MPH (Cincinnati Children’s Hospital Medical Center, Department of Pediatrics), who performed the geocoding for this dataset to provide aggregate measures of census tract poverty. Dr. Goyal had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Financial Disclosures

The authors have no relevant financial relationship to disclose. This work was funded internally by the Division of Neonatology and the Division of General and Community Pediatrics.

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Authors and Affiliations

  1. Division of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave. ML# 7009, Cincinnati, OH, USA

    Neera K. Goyal, Scott L. Wexelblatt & James M. Greenberg

  2. Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Neera K. Goyal

  3. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Neera K. Goyal, Eric S. Hall, Robert S. Kahn, Scott L. Wexelblatt, James M. Greenberg, Zeina M. Samaan & Courtney M. Brown

  4. Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Eric S. Hall

  5. Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Robert S. Kahn, Zeina M. Samaan & Courtney M. Brown

  6. Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave. ML# 7009, Cincinnati, OH, 45229, USA

    Neera K. Goyal

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  1. Neera K. Goyal
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Goyal, N.K., Hall, E.S., Kahn, R.S. et al. Care Coordination Associated with Improved Timing of Newborn Primary Care Visits. Matern Child Health J 20, 1923–1932 (2016). https://doi.org/10.1007/s10995-016-2006-0

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  • DOI: https://doi.org/10.1007/s10995-016-2006-0

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