«Transition to Home after Preterm Birth»

Transkript

1 «Transition to Home after Preterm Birth» An Advanced Practise Nurse (APN) led New Model of Tranistional Care Development and Evaluation Natascha Schütz Hämmerli, MScN, RN Eva Cignacco, Susanne Draber, Dorothée Eichenberger zur Bonsen, Luzia Herrmann, Mathias Nelle, Lilian Stoffel, Ulrich Von Allmen Berner Fachhochschule Gesundheit Geburtshilfe Inselspital Universitätsklinik für Kinderheilkunde Neonatologie Swiss society of Paediatrics, Annual Meeting 9th June 2016, Kursaal, Bern, Switzerland

2 Overview Why is there a need for a new model to optimize transitional care for families with a preterm child? Project goals The new model of care Planned Pilotstudy

3 Why is there a need for a new model to optimize transitional care for families with a preterm child?

4 Background Preterm Child Incidence CH: 7.2 % 10 % of whom < 32 weeks GA Hospitalisation: 3-4 month Morbiditiy: high risk for long-term consequences (eg. motor, cognitive, behavioral impairment) Impact on Parents Emotional: distress, depression, anxiety, posttraumatic stress disorders, lower selfefficacy, sensitivity, bonding-quality, Long-term impact on: Parent-child interaction and child development Transition from Hospital to Home: Unpreparedness, inadequate caregiver education, increased needs for knowledge and support after discharge, poor coordination of post discharge services Economic Impact longest average length of hospital stay Highest readmission rates (all neonates) 35 % in CH High use of emergency and primary care ressources lack of comprehensive data generally limited to direct health care costs of the hospitalization underestimated burden for society Bucher, 2002; 2009; Bundesamt für Statistik, 2015; European Foundation for the Care of Newborn Infants, 2009/2010; Holditch- Davis et al. 2000, 2003, 2009; Hynan et al., 2013; Latal, 2009; Leijon et al., 2003; Melnyk et al., 2006, 2008; Schütz Hämmerli et al., 2012; Singer et al. 1999; Stoll et al., 2015; Thomas et al., 2009; Underwood et al., 2007 Wade et al. 2008;

5 Goal of the Project 1. Development and implementation of a new, sustainable and interprofessional model of care to optimize transition from hospital home and to support families with a preterm child 2. Evaluation of effectiveness of the model and cost analysis

6 Project structure Transition to Home Development of a new model of care (including sustainable funding) to optimize transitional care for families with a preterm child. Definition of the interprofessional interventions (e.g. home visits, follow-up calls, consultations, etc.) based on 2 existing transitional care models. Role development of the Advanced Practice Nurse Establishment of a professional network Operational concept Translation of the operational concept into practice Set up of infrastrtuctures and environment Provision of work sheets and documents Health care professionals training Practice development Scientific evaluation of the model of care Development, preparation and performance of a pilot study Development, preparation and performance of an intervention study Research

7 The new model of Transitional care

8 Goals of the optimized transitional care Assurance and improvement of the premature infants treatment success Assessment and strengthening of personal resources of the parents, the family and the environment Promotion and strengthening of parental mental health, such as reducing depressive symptoms, anxiety, PTSD and promoting higher sensitivity, quality of attachment, self-efficacy, quality of life and positive parent-child interaction Promotion of a positive child development Reducing length of hospital stay, readmission rates and unnecessary emergency consultations

9 Prototype of model of care Ambulante Versorgung Spital Arzt/in (Neonatologe, Entwicklungspädiater etc.) Hebamme Musiktherapie Pflegfachperson Physiotherapeut/in Psychologe/in Stillberatung Sozialberatung Advanced Practice Nurse (APN)/ Advanced Practice Midwife (APM) Arzt/in (Pädiater, Neontaologe etc) Hebamme Heilpädagoge/in Früherziehung Kinderspitex Musiktherapie Zu Hause Mütter- Väterberatung Physiotherapeut/in Psychologe/in Regional Nachsorgeangebote Kontinuierliche Begleitung durch APN Erstkontakt Psychologin Erstkontakt APN Geburt Familieim Spital Nachsorge Planung basierend auf Bedarfsabklärung Nachsorge Bedarfsabklärung Eltern Frühgeborenes Geschwister Verwandte Umfeld Austritt Hausbesuche und telefonische Beratung durch APN Übergabe der Fallführung von weiter unterstützungsbedürftigen Familien 3-4 Monate 6 Monate

10 Services of the Advanced Practice Nurse Continous, individual family centerd counseling After care needs assessment Comprehensive, individual discharge planning Coordination of the interprofessional services and interventions during and after hospitalisation Individual and Group education (some together with other professionals) Telephone counseling after discharge Follow-up home visits Outpatient consultation toghether with the Neonatologist

11 Service and interventions of the interprofessional Team Outpatient consultation toghether with the APN Psychotherapeutic Interventions Educational sequences / Group Education (Basic Infant care, lactation etc.) Extended lactation counseling Musictheapeutic outpatient service Extended services of the physiotherapist Service of community care counseling Services of the early developmental therapists

12 Planned Pilot Study

13 Pilotstudy ( ) «Transition to Home after Preterm Birth: Pilot Testing of an Advanced Practice Nurse-led New Model of Transitional Care» Study aims: 1. Evaluate the new transitional care model from a health care provider perspective (qualitative) 2. Evaluate the new transitional care model from a parent perspective (qualitative and quantitative) 3. Describe differences between the intervention and control group on: a) parental mental health and well-being; b) parental satisfaction; c) parent-child interaction; d) child developmental outcomes (quantitative). 4. Evaluate the preliminary costs of the new model of care and determine morbidity and reasons for readmission (quantitative)

14 Setting and Sample Study Aim 3 Setting: Neonatology of the University Children s Hospital Bern Sample: Intervention Group: N=small sample of families Control Group: N=matched sample of families Inclusion criteria: Families with preterm children with a gestational age of 24 0/7 34 6/7 weeks Born and hospitalized in the study centre children discharged directly from Neonatology families resident in the Canton of Bern

15 Methods Study Aim 3 Study type Outcomes Data collection time point Analysis Comparative clinical trial Parent-child interaction (both) 4 (numbers referring to time points) Parents: Depressive symptoms 1,2,3,4, anxiety 1,2,3,4, PTSD 1,2,3,4, parenting stress 1,2,3,4, quality of attachment 1,2,3,4, self-efficacy 1,2,3,4, sensitivity 1,2,3,4, quality of partner relationship 1,2,3,4 Children: nutrition management 1,3,4, growth status 1,2,3,4, feeding behaviors 1,2,3,4, social, motor and cognitive development 3, sleep patterns, self-regulation ability 1,2,3,4 Before discharge 1 1 month corrected age 2 3 month corrected age (together with follow-up examination) 3 6 month corrected age 4 Descriptive and inferential statistics

16 Expected benefit and possible application of results detailed insight into the feasibility of different interventions within the Transition to Home Model basis for a subsequent longitudinal interventional comparative effectiveness study Reduced parental emotional burden Better parental well-being Better parent-child interaction Enhanced child development

17 Thank your for your attention! The project is supported by: Zwillenberg Stiftung