Impact of Longitudinal Care Coordination on Medically Complex Infant Outcomes in a Level IV Neonatal Intensive Care Unit

OBJECTIVE Evaluate the impact of a level IV neonatal intensive care unit (NICU) longitudinal care coordination program (LCCP) for medically complex infants on resource utilization outcomes. METHODS We conducted a longitudinal observational study of 95 infants admitted to a level IV NICU and enrolled in a new LCCP from 2018 to 2021. Two-year survival and follow-up rates were compared with a historical cohort of 96 NICU patients admitted the year prior to program initiation. To assess enrollment efficiency over time, data were compared across three 1-year epochs. Comprehensive data were collected to assess changes in (1) hospital length of stay and (2) efficiency in time to program enrollment, and identification of patients with highest complexity of medical and social needs. Secondary outcomes included (1) survival after discharge and (2) compliance with outpatient follow-up. RESULTS As compared with the preprogram cohort, LCCP-enrolled patients were more medically complex, with lower median gestational age and birth weight and a higher degree of organ system involvement and subspecialty consultations. LCCP families were more likely to have significant health literacy concerns (27% vs 2%; P < .001). Over the 3-year period, time to enrollment became more efficient. LCCP patients had longer length of hospitalization; however, follow-up rates were higher in the LCCP group (0% lost to follow-up) with significantly improved 2-year survival (86% vs 76%; P < .001). CONCLUSIONS The program identified more medically complex patients, with increased efficiency over time and improved survival and outpatient follow-up after discharge. LCCP may be a transferable model for medically complex infants.