Implementation of a Consensus-Based Discharge Protocol for Preterm Infants With Lung Disease

Study Overview
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Brief Summary
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The researchers have worked to create consensus recommendations among national efforts to help with the transition and coordination of care for preterm infants with lung disease around discharge from the neonatal intensive care unit to home. This study looks to evaluate implementation of the recommendations at Boston Children's Hospital and referring NICU's (Beth Israel Deaconess Medical Center and Brigham and Women's Hospital). Specifically, the research team will be looking at follow-up rates, healthcare utilization, and parental satisfaction/feedback with implementation of these guidelines.

Detailed Description
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Premature infants with bronchopulmonary dysplasia (BPD) have complex care needs around discharge. BPD affects up to 40% of former preterm infants born at <28 weeks gestation, with about 10,000 new cases of BPD in the United States every year. Healthcare utilization in this population in the first two years of life is high, with increased hospitalizations, visits, and medication usage. Coordinated follow-up programs may help improve outcomes and reduce rates of hospitalization in this population. However, guidelines do not exist to identify which infants discharging from the NICU should be targeted for specialty follow-up for their respiratory disease, the time frame and format that this should occur, and which evaluations should be performed routinely around discharge. This will be an implementation study, measuring outcomes 3 months prior and 3 months after enactment of a discharge bundle for preterm infants with BPD at local NICUs (Brigham and Women's Hospital, Beth Israel Deaconess Medical Center) who will be followed by Boston Children's Hospital.

Official Title
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Implementation of a Consensus-Based Discharge Protocol for Preterm Infants With Lung Disease

Conditions
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Bronchopulmonary Dysplasia

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Preterm infants born <32 weeks with at least mild BPD, defined as 28 days of respiratory support after birth. Efforts will be made to include a mix of infants with mild, moderate, and severe BPD, including infants discharged on oxygen. Exclusion Criteria: Discharge to a location other than home. Infants with other congenital disease (cardiac, genetic, neurological) thought to contribute significantly to their respiratory disease.

Ages Eligible for Study
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Minimum Age: 0 Days
Maximum Age: 1 Year

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pre-Guideline Implementation<br>Participants in this group will be recruited during the first 3 months of the study and the time will be used for baseline data collection with existing standards of care around discharge practices of infants with BPD | |
| Post-Guideline Implementation<br>After 3 months, the discharge bundle developed from consensus from the Delphi process will be introduced to both NICUs using Quality Improvement principles. Participants will be recruited after the introduction of the discharge bundle. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Healthcare Utilization | Review of emergency encounters, urgent care visits, and hospital readmissions in the first 6 months after NICU discharge. | 8 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rates of pulmonary follow-up and use of telemedicine in follow-up | Review of medical record | 8 months | 
| Completion of recommended evaluations and testing | Review of medical record | 8 months | 
| Medication use | Review of medical record | 8 months | 
| Home oxygen use | Review of medical record | 8 months | 
| Feeding | Review of medical record | 8 months | 
| Family satisfaction with care for respiratory symptoms around and after discharge | Assessed by surveys | 8 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Bronchopulmonary Dysplasia, NICU Discharge