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Neonatal Follow-up

NICU Follow Up and Neurodevelopment 5: Impact of Parents and Social Determinants of Health

155 - Social Needs and Health Care Utilization in Neonatal Intensive Care Unit (NICU) Graduates

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 155
Publication Number: 155.363

Cecile Yama, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Rachel G. Greenberg, Duke Clinical Research Institute, Durham, NC, United States; Deesha Mago-Shah, Duke University School of Medicine, Durham, NC, United States

Presenting Author(s)

Cecile Yama, MD (she/her/hers)

Post Doctorate Fellow/ National Clinician Scholar
University of California, Los Angeles David Geffen School of Medicine
Los Angeles, California, United States

Background: Once discharged after birth, infants who spend time in the NICU are high utilizers of costly care. Social needs (SN) are associated with increased healthcare utilization (HCU) in children and adults, however this has not been studied in NICU graduates.

Objective: We sought to examine the association between social needs and post-discharge healthcare utilization in NICU graduates.

Design/Methods: A SN screening questionnaire was administered at each infant’s first visit in an academic NICU follow-up clinic starting in August 2021, using the North Carolina’s Department of Health and Human Services standardized screening tool. We identified 112 infants who received SN screening between August 2021- June 2022, and calculated a rate of healthcare encounters per month for each infant. We used non-parametric statistical tests to examine: 1) The association between screening positive for any SN (“Global SDH positive”) and healthcare utilization (phone, hospitalization, emergency room and total encounters and no-show rates) 2) The association between specific needs: food, housing and transportation insecurity, with healthcare utilization.

Results: In our NICU follow up clinic population, 18% of infants screened positive for a SN (N=20), with transportation being the most common need (65%) (Table 1, 2). Overall, infants with any SN compared to those without needs, had a higher frequency of hospitalizations (.14 hospitalizations/month vs .07/month), greater number of total healthcare encounters (.92 encounters/month vs. .45/month) and a higher percentage of no-shows to appointments (12.5 % no-show rate vs. 3.3%) (Table 2). Increased SN were not significantly associated with increased ED visits or phone encounters. Infants with insecurities in food (12.1% no-show), housing (13.2% no -show) or transportation (13.9% no-show) all demonstrated a higher clinic no-show rate than infants without any needs (3.4% no-show). Transportation insecurity was associated with more frequent hospitalizations (.13 encounters/month) and total encounters (1.24/month) compared to those without transportation insecurity (.08/month, .44/month respectively).

Conclusion(s):

Ours is the first study to examine the association between social needs and healthcare utilization in a NICU discharge population. Infants with SN had higher rates of hospitalizations, total encounters, and no-shows. Though our study is limited by potential confounding and generalizability, due to our sample size, it represents early evidence for screening for social needs in the NICU population as a predictor of increased no-show rates and healthcare utilization.