Baby CareLink: Using the Internet and telemedicine to improve care for high-risk infants

Objective. To evaluate an Internet-based telemedicine program designed to r educe the costs of care, to provide enhanced medical, informational, and em otional support to families of very low birth weight (VLBW) infants during and after their neonatal intensive care unit (NICU) stay. Background. Baby CareLink is a multifaceted telemedicine program that incor porates videoconferencing and World Wide Web (WWW) technologies to enhance interactions between families, staff, and community providers. The videocon ferencing module allows virtual visits and distance learning from a family' s home during an infant's hospitalization as well as virtual house calls an d remote monitoring after discharge. Baby CareLink's WWW site contains info rmation on issues that confront these families. In addition, its security a rchitecture allows efficient and confidential sharing of patient-based data and communications among authorized hospital and community users. Design/Methods. A randomized trial of Baby CareLink was conducted in a coho rt of VLBW infants born between November 1997 and April 1999. Eligible infa nts were randomized within 10 days of birth. Families of intervention group infants were given access to the Baby CareLink telemedicine application. A multimedia computer with WWW browser and videoconferencing equipment was i nstalled in their home within 3 weeks of birth. The control group received care as usually practiced in this NICU. Quality of care was assessed using a standardized family satisfaction survey administered after discharge. In addition, the effect of Baby CareLink on hospital length of stay as well as family visitation and interactions with infant and staff were measured. Results. Of the 176 VLBW infants admitted during the study period, 30 contr ol and 26 study patients were enrolled. The groups were similar in patient and family characteristics as well as rates of inpatient morbidity. The Car eLink group reported higher overall quality of care. Families in the CareLi nk group reported significantly fewer problems with the overall quality of care received by their family (mean problem score: 3% vs 13%). In addition, CareLink families also reported greater satisfaction with the unit's physi cal environment and visitation policies (mean problem score: 13% vs 50%). T he frequency of family visits, telephone calls to the NICU, and holding of the infant did not differ between groups. The duration of hospitalization u ntil ultimate discharge home was similar in the 2 groups (68.5 +/- 28.3 vs 70.6 +/- 35.6 days). Among infants born weighing <1000 g (n = 31) there was a tendency toward shorter lengths of stay (77.4 +/- 26.2 vs 93.1 +/- 35.6 days). All infants in the CareLink group were discharged directly to home w hereas 6/30 (20%) of control infants were transferred to community hospital s before ultimate discharge home. Conclusions. CareLink significantly improves family satisfaction with inpat ient VLBW care and definitively lowers costs associated with hospital to ho spital transfer. Our data suggest the use of telemedicine and the Internet support the educational and emotional needs of families facilitating earlie r discharge to home of VLBW infants. We believe that further extension of t he Baby CareLink model to the postdischarge period will significantly impro ve the coordination and efficiency of care.