Differentiate Your NICU Services With Family-Centered Care and Big Data
At Sg2, we have been tracking several key trends in neonatology this year, from payment innovation to care regulations. Last month, we were excited to see 2 trends that we have been watching closely reflected at the Vermont Oxford Network (VON) Annual Quality Conference, which took place in Chicago, IL, bringing together nearly 1,200 neonatology health care professionals. We expect both increased focus on the patient experience and the advent of Big Data to have a significant impact on neonatology care delivery in the coming decade, including reducing length of stay in the neonatal intensive care unit (NICU).
Expect a Drop in NICU Volumes and Increased State Regulations
At Sg2, we are anticipating a 10% decrease in neonatology discharges over the next decade. Key drivers of this decline include improved prenatal care for mothers, protocol changes and payment innovation. We have been projecting this decline for a number of years now, and historical birth data suggest not only that the preterm birth rate has peaked, but that neonatology discharges have as well.
Another factor impacting NICU care delivery is an increase in state regulations regarding appropriate levels of care. Several studies have shown that organizations with more than 50 very low birthweight (VLBW) deliveries annually have lower mortality and morbidity rates than those with fewer than 50, and those with 100 or more VLBW deliveries annually have even better outcomes.
States are taking these results, as well as the 2012 American Academy of Pediatrics (AAP) guidelines for NICU levels of care, into account when developing new regulations. Health care organizations seeking to provide high-quality NICU care must ensure that both volume and quality of care remains high, leading to potential for market share battles and regionalization of neonatology services. In addition, patients will increasingly seek out organizations based on care quality, and quality will play a larger role in payer contracting.
Family-Centered Care May Improve Outcomes, Decrease LOS
Family-centered care may become a key differentiator for NICUs competing on quality. Family-centered care includes design that caters to family needs and processes that empower patients and their families to participate in their treatment, such as training family members to provide care or offering quiet, private spaces for family members and patients. The combination of family-centered care and private rooms for the NICU patient is correlated with higher lactation rates, lower infection rates, increased weight gain and improved neurodevelopmental scores for neonatal patients. Organizations that implement family-centered care models also can expect increased parental preparedness and shorter lengths of stay.
Health systems are increasingly being driven toward transparency, and they are placing more value on patient experience. In 2014, a child HCAHPS survey was released that included questions about newborn patient experience for the first time. This tool provides a mechanism to track performance at the provider level for pediatric care, and although payment is not currently tied to benchmarks associated with this tool, we would anticipate payers to utilize these data in the future.
At the VON Conference, several groups presented data suggesting that parental involvement in neonatal care can improve family satisfaction and engagement. Of particular interest was a case study from Edinburgh, Scotland, which described the Royal Infirmary of England’s efforts to improve communication between NICU staff and patient families. They developed a workflow to encourage communication with family members within the first 24 hours of admission. The team also tracked quantitative data (percent of documented family communication) and qualitative data (publicly posted comment/feedback from parents). After implementing the new workflow, documented communication with families increased from 60% to over 90% within the first 24 hours.
Big Data Are Coming to a NICU Near You
For me, the most exciting session of the conference was on Big Data, or the analysis of large data sets to identify patterns. At Sg2, we ascribe the term “advanced analytics” to describe the use of Big Data in health care, or the interdisciplinary field that studies and pursues the effective uses of biomedical data, patient-generated data, information and knowledge for scientific inquiry, problem solving and decision making to improve human health. This is an oft-discussed yet nebulous term, and it can be challenging to find tangible examples showing how Big Data impact clinical care. Yet, we expect Big Data to have a significant impact on care delivery, in the NICU in particular. Below are 2 examples highlighting how advanced analytics are impacting the NICU today.
Genetic Testing Improves and Speeds Diagnoses in the NICU
Genetic testing has already changed the diagnostic landscape. Cell-free DNA testing of fetal chromosomes replaced existing screening modalities for fetal chromosomal anomalies and dramatically reduced diagnostic tests such as amniocentesis. For neonates, genetic diagnostics are potentially more impactful, because the majority of rare genetic conditions will present in the NICU. Whole genome sequencing moves genetic analytics beyond screening for genetic anomalies to become a diagnostic tool for the 4,600 known rare genetic conditions.
At the VON Conference, Children’s Mercy Hospital described how it is pairing a rapid whole genome sequencing technique, which can generate sequencing data within 26 hours, with a computer-generated differential diagnosis based upon patient symptoms. Together, this Big Data–based diagnostic can provide a definitive diagnosis for infants with rare genetic conditions in less than 50 hours. A recently published study found that whole genome sequencing was able to generate a definitive diagnosis in 57% of cases, compared to 9% using standard methods. That diagnosis was clinically relevant, and in 65% of cases impacted the clinical care plan. This technology will change care delivery for NICU patients with these conditions; for example, it can help families make earlier decisions regarding the use of palliative measures.
Genome Sequencing Cost Drops From a High of $100M to $1K
The cost of sequencing has dropped dramatically, from over $100M in the early part of the millennium to $1,000 today. If the cost of sequencing continues to fall, the technology will be within reach of all patients, not just those with rare genetic anomalies. Organizations should consider the impacts of patients’ demands for access to their (and their children’s) genetic information. Whole genome sequencing could become standard care for all patients; having access to genetic information will influence how care decisions are made. In addition to being used to identify rare, hard-to-diagnose conditions and reduce length of stay, sequencing data could also reveal more common genetic conditions that patients and their families have, improving decision making about specific treatments and, in turn, reducing subsequent procedures or admissions for those patients.
Organizations with high-level NICUs should consider adopting or partnering to improve their access to sequencing technology. At Sg2, we anticipate that increased awareness among parents will create demand for this service. Family members may seek information elsewhere if they cannot access this testing at your facility. Offering this service would require increased investment not only in the technology and staff required to perform the sequencing and analysis, but also in the genetic counselors and support teams to help families process and effectively utilize the information.
Prepare for and Monitor Innovations’ Disruptive Impact on Your NICU
It is an exciting time for neonatology innovation, and both sequencing technology and family-centered care will have a lasting impact on how neonatology care is delivered today and in the future. Some final takeaways to consider:
- Recognize the implications of utilization trends on NICU strategy and financial outcomes. These 2 innovations will not directly impact patient volumes, but will have a significant impact on total days in the NICU. Organizations must prepare not only for a projected decline in overall admissions to the NICU, but also for a reduced length of stay for the remaining patients. These trends will impact facility design and staffing requirements and could impact the level of care designation for certain NICUs.
- Monitor potential disruption impacting NICU services. Both of these trends could potentially disrupt NICU care delivery, from the need to retrain and redeploy staff to reductions in traditional diagnostics for neonates. Organizations should be aware of new care models and decide on an organization-wide approach to disruption (eg, stay the course or lead the way).
HCAHPS = Hospital Consumer Assessment of Healthcare Providers and Systems.
Sg2 Associate Vice President Madeleine McDowell, MD, FAAP, contributed to this post.
Tags: children's, children's hospitals, family-centered care, genetics, genome, neonatal intensive care unit, neonatology, NICU, patient-centered care, pediatrics, Vermont Oxford Network, VON conference