TY - JOUR
T1 - Effectiveness of Alberta Family Integrated Care on infant length of stay in level II neonatal intensive care units
T2 - a cluster randomized controlled trial
AU - the Alberta FICare Level II NICU Study Team
AU - Benzies, Karen M.
AU - Aziz, Khalid
AU - Shah, Vibhuti
AU - Faris, Peter
AU - Isaranuwatchai, Wanrudee
AU - Scotland, Jeanne
AU - Larocque, Jill
AU - Mrklas, Kelly J.
AU - Naugler, Christopher
AU - Stelfox, H. Thomas
AU - Chari, Radha
AU - Soraisham, Amuchou Singh
AU - Akierman, Albert Richard
AU - Phillipos, Ernest
AU - Amin, Harish
AU - Hoch, Jeffrey S.
AU - Zanoni, Pilar
AU - Kurilova, Jana
AU - Lodha, Abhay
N1 - Funding Information:
This study was supported by Alberta Innovates – Health Solutions, Partnership for Innovation in Health Services Research (PRIHS; grant number 201400399). The funder had no role in the design and conduct of the study; the collection, analysis, and interpretation of data; or the writing of the manuscript. The following trainees received funding related to this study: Meredith Brockway received doctoral scholarships from ACHRI and the Alberta Strategy for Patient Oriented Research (AbSPOR); Samantha Delhenty received a Master of Nursing Graduate Scholarship from the Faculty of Nursing, University of Calgary; Catherine Ringham received post-doctoral funding from the PRIHS grant that was leveraged for a successful CIHR– Health Systems Impact Fellowship for provincial scale and spread of Alberta FICare™.
Funding Information:
KB reports a grant from the Canadian Institutes of Health Research (CIHR) and Alberta Children’s Hospital Research Institute (ACHRI) for follow-up studies of Alberta FICare™. HTS is supported by an Embedded Clinician Researcher Salary Award from CIHR. All other authors declare that they have no competing interest.
PY - 2020/12
Y1 - 2020/12
N2 - Background: Parents of infants in neonatal intensive care units (NICUs) are often unintentionally marginalized in pursuit of optimal clinical care. Family Integrated Care (FICare) was developed to support families as part of their infants’ care team in level III NICUs. We adapted the model for level II NICUs in Alberta, Canada, and evaluated whether the new Alberta FICare™ model decreased hospital length of stay (LOS) in preterm infants without concomitant increases in readmissions and emergency department visits. Methods: In this pragmatic cluster randomized controlled trial conducted between December 15, 2015 and July 28, 2018, 10 level II NICUs were randomized to provide Alberta FICare™ (n = 5) or standard care (n = 5). Alberta FICare™ is a psychoeducational intervention with 3 components: Relational Communication, Parent Education, and Parent Support. We enrolled mothers and their singleton or twin infants born between 32 0/7 and 34 6/7 weeks gestation. The primary outcome was infant hospital LOS. We used a linear regression model to conduct weighted site-level analysis comparing adjusted mean LOS between groups, accounting for site geographic area (urban/regional) and infant risk factors. Secondary outcomes included proportions of infants with readmissions and emergency department visits to 2 months corrected age, type of feeding at discharge, and maternal psychosocial distress and parenting self-efficacy at discharge. Results: We enrolled 654 mothers and 765 infants (543 singletons/111 twin cases). Intention to treat analysis included 353 infants/308 mothers in the Alberta FICare™ group and 365 infants/306 mothers in the standard care group. The unadjusted difference between groups in infant hospital LOS (1.96 days) was not statistically significant. Accounting for site geographic area and infant risk factors, infant hospital LOS was 2.55 days shorter (95% CI, − 4.44 to − 0.66) in the Alberta FICare™ group than standard care group, P =.02. Secondary outcomes were not significantly different between groups. Conclusions: Alberta FICare™ is effective in reducing preterm infant LOS in level II NICUs, without concomitant increases in readmissions or emergency department visits. A small number of sites in a single jurisdiction and select group infants limit generalizability of findings. Trial registration: ClinicalTrials.gov Identifier NCT02879799, retrospectively registered August 26, 2016.
AB - Background: Parents of infants in neonatal intensive care units (NICUs) are often unintentionally marginalized in pursuit of optimal clinical care. Family Integrated Care (FICare) was developed to support families as part of their infants’ care team in level III NICUs. We adapted the model for level II NICUs in Alberta, Canada, and evaluated whether the new Alberta FICare™ model decreased hospital length of stay (LOS) in preterm infants without concomitant increases in readmissions and emergency department visits. Methods: In this pragmatic cluster randomized controlled trial conducted between December 15, 2015 and July 28, 2018, 10 level II NICUs were randomized to provide Alberta FICare™ (n = 5) or standard care (n = 5). Alberta FICare™ is a psychoeducational intervention with 3 components: Relational Communication, Parent Education, and Parent Support. We enrolled mothers and their singleton or twin infants born between 32 0/7 and 34 6/7 weeks gestation. The primary outcome was infant hospital LOS. We used a linear regression model to conduct weighted site-level analysis comparing adjusted mean LOS between groups, accounting for site geographic area (urban/regional) and infant risk factors. Secondary outcomes included proportions of infants with readmissions and emergency department visits to 2 months corrected age, type of feeding at discharge, and maternal psychosocial distress and parenting self-efficacy at discharge. Results: We enrolled 654 mothers and 765 infants (543 singletons/111 twin cases). Intention to treat analysis included 353 infants/308 mothers in the Alberta FICare™ group and 365 infants/306 mothers in the standard care group. The unadjusted difference between groups in infant hospital LOS (1.96 days) was not statistically significant. Accounting for site geographic area and infant risk factors, infant hospital LOS was 2.55 days shorter (95% CI, − 4.44 to − 0.66) in the Alberta FICare™ group than standard care group, P =.02. Secondary outcomes were not significantly different between groups. Conclusions: Alberta FICare™ is effective in reducing preterm infant LOS in level II NICUs, without concomitant increases in readmissions or emergency department visits. A small number of sites in a single jurisdiction and select group infants limit generalizability of findings. Trial registration: ClinicalTrials.gov Identifier NCT02879799, retrospectively registered August 26, 2016.
KW - Bundled model of care
KW - Family centered care
KW - Family integrated care
KW - Health services research
KW - Length of stay
KW - Neonatal intensive care unit
KW - Parent education
KW - Parent support
KW - Preterm infant
KW - Relational communication
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U2 - 10.1186/s12887-020-02438-6
DO - 10.1186/s12887-020-02438-6
M3 - Article
C2 - 33246430
AN - SCOPUS:85096752435
VL - 20
JO - BMC Pediatrics
JF - BMC Pediatrics
SN - 1471-2431
IS - 1
M1 - 535
ER -