639 - Disparities in Unmet Medical Needs After Neonatal Intensive Care Unit (NICU) Discharge

Poster Number: 639
Publication Number: 639.141

Tamiko Younge, Children's National Health System, washington, DC, United States; Marni Jacobs, University of California, San Diego School of Medicine, La Jolla, CA, United States; Lamia Soghier, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Karen Fratantoni, US FDA, Silver Spring, MD, United States

Background: Health care service readiness is an essential part of discharge for the high-risk neonate. Service needs of NICU graduates are inadequately studied. Prior research has focused on acute and emergency care rather than routine utilization and unmet medical needs.

Objective: Identify types of unmet medical needs, the effect of peer support, and associations with infant and sociodemographic factors for infants and their families one year after NICU discharge.

Design/Methods: 300 families at a level IV referral NICU were randomized to receive a post-discharge peer-to-peer support intervention versus standard care. 240 participants completed medical needs assessment 12 months after discharge reporting if their child did not need, needed and received, or needed but did not receive 7 services (primary care, specialty care, therapies, home nursing, childcare, prescription medications, and equipment). Infant characteristics included sex, gestational age, birthweight, length of stay (LOS), and Functional Status Scale (FSS) score. Sociodemographic factors included parent race, education, partner status, and insurance type (Medicaid versus Private or Tricare). Statistical analysis included Pearson’s chi-squared test and logistic regression.

Results: The most prevalent medical needs were primary care (99%), specialty care (68%), and prescription medications (62%). Overall, 14% of families reported at least 1 unmet need. The most prevalent unmet needs were home nursing (17%) and childcare (14%). Randomization to the intervention was not associated with a difference in unmet medical need (p=0.85). Younger gestational age at birth and longer LOS were associated with greater odds of unmet medical need (OR=0.91, 95% CI [0.84, 0.97]; OR=1.01, 95% CI [1.01, 1.02]). Parent race was significantly associated with differences in unmet medical needs (p=0.02). Black parents had 3.3 times the odds of reporting unmet needs compared to white parents (95% CI [1.35-8.24]). Parental education, Medicaid insurance, and partner status were not associated with differences in unmet medical needs.

Conclusion(s): Unmet medical needs are common for NICU families after discharge. Peer support did not appear to affect these needs. Significant racial disparities exist which appear unrelated to insurance status or level of education. This suggests specific barriers to accessing services for black families. Further research is needed to identify these barriers and implement solutions.