The Impact Of Medical Home Model On Neurological And Developmental Outcomes Of Preterm Infant

Yıl 2016, Cilt: 13 Sayı: 1, 22 - 27, 01.01.2016

Zeynep Eras H. Gözde Kanmaz Halil İbrahim Yakut Nilüfer Güzoğlu Emre Canpolat Suna Oğuz Nurdan Uraş

Öz

Aim: The medical home also known as the patient-centered medical care, is a team based health care delivery model led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. The aim of the study is to compare the 2-year neurodevelopmental outcomes of very preterm infants who received health care in a medical home at a big maternity hospital in Turkey with the historical controls who delivered standard care.Material and Methods: Inborn infants who were ≤32 week’s gestation and discharged between September 2007 and December 2011 were enrolled to the study. Intervention group were prospectively followed within the concept of medical home between September 2009 and December 2011 and the control group were followed with standard health care between September 2007 and September 2009 . At 18-24 months’ of corrected age, the neurological examinations and the developmental assessments using the Bayley Scales of Infant Development-II were performed.Results: The cerebral palsy rates in the intervention and control group were 10.6% n=17 and 17.4% n=27 respectively and the difference was not statistically significant p=0.107 . Whereas the rate of neurodevelopmental impairment in the intervention group was significantly lower than the control group 25% and 38.7%; p=0.011 .Conclusion: Our data suggest that beginning a good follow-up process within the context of medical home, with efficient developmental support and guidance provided a reduction on neurodevelopmental impairment rate at 2 years of age.

Anahtar Kelimeler

Prematurity, neurodevelopment, medical home, primary health care

Bütüncül İzlem Modelinin Preterm Bebeklerin Nörolojik Ve Gelişimsel Sonuçları Üzerine Etkisi

Öz

Giriş: Çalışmanın amacı Türkiye’de büyük bir doğum hastanesinde taburculuk sonrası yapılan bütüncül izlem modeli ile izlenen preterm bebekler ile birinci basamakta sağlık hizmeti alan preterm bebeklerin 2 yaştaki nörolojik ve gelişimsel sonuçlarını karşılaştırmaktı.Gereç ve Yöntemler: Çalışmaya 32 gestasyon haftası ve altında doğan, Ekim 2007 ile Aralık 2011 arasında taburcu olan bebekler alındı. Girişim grubu bütüncül izlem modeli kapsamında prospektif olarak izlendi Ekim 2009-Aralık 2011 ve kontrol grubu birinci basamakta standart sağlık hizmeti aldı Ekim 2007-Aralık 2009 . Diizeltilmis 18-24 aylarmda bebeklerin nörolojik muayeneleri ve “Bayley Bebekler için Gelişimi Değerlendirme Ölceği II” ile gelişimsel değerlendirmeleri yapıldı.Bulgular: Girişim grubunun %10.6 n=17 ve kontrol grubunun %17.4 n=27 ’ünde serebral palsi saptandı ve gruplar arasındaki fark anlamlı değildi p=0.107 . Ancak gelişimsel sorun oranının girişim grubunda kontrol grubuna göre anlamlı düzeyde düşük olduğu saptandı %25 ve %38.7; p=0.011 .Sonuç: Bulgularımız, bütüncül izlem modeli kapsamında yapılan iyi bir izlem, yeterli gelişimsel destek ve sorunların erken farkedilip yönlendirme yapılmasının 2 yaştaki nörolojik ve gelişimsel sorunların görülme oranında azalma sağlayabileceğini göstermiştir.

Anahtar Kelimeler

Prematürite, nörolojik ve gelişimsel sonuç, bütüncül izlem modeli, birinci basamak sağlık izlemi

Kaynakça

• Fanaroff AA, Stoll BJ, Wright LL, et al. Trends in neonatal morbidity and mortality for very low birth weight infants. Am J Obstet Gynecol 2007 ;196:147.
• Mikkola K, Ritari N, Tommiska V, et al. Neurodevelopmental outcome at 5 years of age of a national cohort of extremely low birth weight infants who were born in 1996-997. Pediatrics 2005;116:1391-1400.
• Kelly MM. The medically complex premature infant in primary care. J Pediatr Health Care 2006;20:367-373.
• Marlow N, Wolke D, Bracewell MA,et al. Neurologic and developmental disability at six years of age after extremely preterm birth. N Eng J Med 2005;352:9-19.
• Roze E, van Braeckel KNJA, van der VeereCN,et al. Functional outcome at school age of preterm infants with periventricular hemorrhagic infarction. Pediatrics 2009; 123:1493–500.
• Luregn J. Schlapbach, Maude Aebischer, Mark Adams, et al and the Swiss Neonatal Network and Follow-Up Group. Impact of Sepsis on Neurodevelopmental Outcome in a Swiss National Cohort of Extremely Premature Infants. Pediatrics 2011;128;348.
• Schmidt B, Asztalos EV, Roberts RS,et al. Impact of bronchopulmo- nary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms. JAMA 2003;289:1124–1129
• Bruggink JLM, van Braeckel KNJA, Bos AF. The early motor repertoire of children born preterm is associated with intelligence at school age. Pediatrics 2010;125: 1356–63.
• Homer CJ, Klatka K, Romm D, et al. A review of the evidence for the medical home for children with special health care needs. Pediatrics 2008;122:922-937.
• Council on Children with Disabilities. Role of the medical home in fa- mily-centered early intervention services. Pediatrics 2007;120:1153- 1158.
• American Academy of Pediatrics, Medical Home Initiatives for Children with Special Needs Project Advisory Committee.Policy statement: orga- nizational principles to guide and define the child health care system and/ or improve the health of all children. Pediatrics 2004;113:1545-1547.
• Palfrey VS, Sofis LA, Davidson EJ, et al. The pediatric alliance for coordinated care: Evaluation of a medical home model. Pediatrics 2004;113:1507-1516.
• Baruffi G, Miyashiro L, Prince GB, et al. Factors associated ease of com- munity-based systems of care for CSHCN in Hawaii. Matern Child Health J 2005;9:99-108.
• Kuehn BM. Patient-centered care model demands better physician-pa- tient communication. JAMA 2012;307:441-2
• Schlapbach LJ, Aebischer M, Adams M, et al; Swiss Neonatal Network and Follow-Up Group.Impact of sepsis on neurodevelopmental outcome in a Swiss National Cohort of extremely premature infants. Pediatrics 2011;128:348-57.
• Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing entero- colitis: therapeutic decisions based upon clinical staging. Ann Surg 1978;187:1–7.
• Papile LA, Munsick-Bruno G, SchaeferA. Relationship of cerebral intra- ventricular hemorrhageand early childhood neurologic handicaps.J Pe- diatr. 1983;103:273–277
• Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am JRespirCrit Care Med. 2001;163:1723–1729.
• An international classification of retinopathy of prematurity: the Com- mittee for the Classification of Retinopathy of Prematurity. Arch Ophtal- mol.1984;102:1130-1134.
• Hagberg B, Hagberg G, Olow I, et al. The changing panorama of cerebral palsy in Sweden. VII. Prevelance and origin in the birth year period 1987-90. ActaPediatr 1996;85:954-960.
• Bayley N. Bayley Scales of Infant Development II. San Antonio, TX: Psy- chological Corp; 1993.
• Mikkola K, Ritari N, Tommiska V, et al. V. Neurodevelopmental outcome at 5 years of age of a national cohort of extremely low birth weight infants who were born in 1996-997. Pediatrics 2005;116:1391-1400.
• Spittle AJ, Ferretti C, Anderson PJ, et al. Improving the outcome of infants born
• Spittle AJ, Orton J, Doyle LW,et al. Early developmental intervention programs post hospital discharge to prevent motor and cogniti- ve impairments in preterm infants. Cochrane Database Syst Rev 2007:CD005495
• Gerteis M, Edgman-Levitan S, Daley J, Delbanco TL. Through the pa- tient’s eyes: Understanding and promoting patient-centered care. San Francisco, CA:Jossey-Bass.) (Donaldson, M. S. (2001). Continuity of care: A reconceptualization. Medical Care Research and Review, 1993;58:255-290
• Gandhi, T. K. Fumbled handoffs: One dropped ball after another. Annals of Internal Medicine, 2005;142:352-358
• Cooley WC, McAllister JW, Sherrieb K, et al. Improved outcomes as- sociated with medical home implementation in pediatric primary care. Pediatrics 2009;124:358-364
• Mangione-Smith R, Schonlau M, Chan KS, et al. Measuring the effec- tiveness of a collaborative for quality improvement in pediatric asthma care: does implementing the chronic care model improve processess and outcomes of care? AmbulPediatr2005;5:75-82
• American Academy of Pediatrics Council with Disabilities, Duby JC. Role of medical home in family centered early intervention services. Pediatrics 2007;20:1153-1158.
• Dorling JS, Field DJ. Follow up of infants following discharge from the neonatal unit: structure and process. Early Hum Dev 2006;82:151-156.
• Castro L, Yolton K, Haberman B, et al. Bias in reported neurodevelop- mental outcomes among extremely low birth weight survivors. Pediatrics 2004;114:404-410.
• Himpens E, van den Broeck C, Ocastra A, et al. Type, distribution and severity of cerebral palsy in relation to gestational age: a meta-analytic review. Dev Med Child Neurol 2008;50:334-340
• Guille´n U, DeMauro S, Ma L, et al. Relationship between attrition and neurodevelopmental impairment rates in extremely preterm infants at 18- 24 months. ArchPediatrAdolesc Med 2012;166:178-184.