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

Context Inner-city high-risk infants often receive limited and fragmented c are, a problem that may increase serious illness. Objective To assess whether access to comprehensive care in a follow-up cli nic is cost-effective in reducing life-threatening illnesses among high-ris k, 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 in eligible or died after randomization but before nursery discharge were excl uded from the analysis. Interventions Infants were randomly assigned to receive routine follow-up c are (well-baby care and care for chronic illnesses; n=441) or comprehensive care (which included the components of routine care plus care for acute il lnesses, with 24-hour access to a primary caregiver; n=446). Main Outcome Measures Life-threatening illnesses (ie, causing death or hosp ital admission for pediatric intensive care) occurring between nursery disc harge and age 1 year, assessed by blinded evaluators from inpatient charts and state Medicaid and vital statistics records; and hospital costs (estima ted 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 routin e-care infants (9 vs 28; P=.001). Identified deaths were similar (11 in com prehensive 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 int ensive care admissions (23 vs 53; P=.003), and 42% fewer intensive care day s (254 vs 440; P=.003). Comprehensive care did not increase the mean estima ted cost per infant for all care ($6265 with comprehensive care and $9913 w ith routine care). Conclusion Comprehensive follow-up care by experienced caregivers can be hi ghly effective in reducing life-threatening illness without increasing cost s among high-risk inner-city infants.