Doctoral Project

Pediatric nurse practitioner home visitation is associated with a decrease in home care and healthcare utilization errors in high risk infants

The Santa Clara Valley Health and Hospital System’s (SCVHHS) Babies Reaching Improved Development and Growth in their Environment (BRIDGE) program was developed in 2011 to optimize high risk infants' care transition from Neonatal Intensive Care Unit (NICU) to home. In addition to hospital discharge teaching and public health nursing efforts, NICU infants need further in home support given their medical vulnerability after discharge. The objectives of the SCVHHS BRIDGE program are to provide caregiver interventions to minimize home care errors after NICU discharge and to optimize health care access and utilization across the transition of care. SCVHHS NICU infants at risk for developmental delay, who met Department of Health and Human Services (DHHS) California Children’s Services (CCS) High Risk Infant Follow-up (HRIF) criteria, qualified for SCVHHS BRIDGE visits. From April of 2011 to January of 2015 Pediatric Nurse Practitioners (PNPs) met caregivers in the NICU, visited homes a minimum of two times after discharge, identified errors, educated caregivers, coordinated care, and facilitated in the resolution of the errors. Errors were defined as a deviation from prescribed plan of care upon discharge from the NICU or after an ambulatory care visit. Data were collected prospectively and Institutional Review Board (IRB) approved. Chi Square with Yates correction was used to assess for significance. Wilcoxon Rank Sum test was used to assess association between gestational age, length of stay, and birth weight in infants with and without errors. Wilcoxon Signed Rank test was used to assess for significance of error reduction across visits. PNPs monitored, educated and attenuated home care errors between home visits and caregivers over time. Collaborating with caregivers and health care providers in the inpatient, home, and outpatient environments, PNPs have the potential to decrease errors, improve health, reduce health care costs, and optimize growth and development for high risk infants.