Establishment of a Family-centred Care Programme with Follow-up Home Visits: Implications for Clinical Care and Economic Characteristics

 

 Buy Article Permissions and Reprints

Abstract

Background:

Elternberatung Frühstart is a family-centred care programme for very preterm infants and seriously ill neonates and their parents. The uniqueness of this programme is in its consistency and continuity in parental counselling from pregnancy at risk to follow-up home visits.

Patients and Methods:

Family-centred care is provided by specialised nurses, a social education worker, a case manager, a psychologist and neonatologists. They give support and information to parents and facilitate transition to home including co-ordination of health care services and support networks. The programme starts with information for parents at risk of preterm delivery to lessen their anxieties and worries. After birth, parental bonding is encouraged and parents are involved in daily care procedures. The following weeks focus on communication, information and education in order to enhance parental competence. Discharge planning and coordinated follow-up visits involve the family doctor and several members of the welfare and health care system. One of the key objectives is to prevent re-hospitalisation. Over a 4 year period 330 families participated. Funding is provided by: 1) the hospital, from admission to discharge equivalent to one full-time nursing staff, 2) charity donations for follow-up visits and 3) health care insurance for social medical aftercare (Bunter Kreis) following §43, 2 SGB V in severe cases.

Results:

As a result of this programme, the median length of stay was reduced by 24 days; the number of patients that stayed longer than average were reduced by 64% in the group of patients born < 1 500 g. At the same time the patient throughput increased from 243 to 413.

Conclusion:

To conclude, a family-centred care programme with coordinated follow-up increases parental satisfaction, reduces the length of the hospital stay and is therefore profitable.

Zusammenfassung

Hintergrund:

Die Elternberatung „Frühstart“ betreut Eltern Frühgeborener und kranker Neugeborener. Die Einzigartigkeit des Konzepts liegt in der Kontinuität der Betreuung durch das gleiche Team von der Risikoschwangerschaft bis in die Häuslichkeit.

Patienten und Methoden:

Das Team besteht aus (Fach-) Kinderkrankenschwestern, einer Case Managerin, einer Sozialpädagogin, einer Psychologin und Neonatologen. Sie unterstützen die Eltern durch Begleitung, Information, Vernetzung und Organisation. Vor der Geburt werden Ängste durch Information genommen, nach der Geburt das Bonding unterstützt, die Eltern in Pflegemaßnahmen einbezogen und die elterliche Kompetenz gestärkt. Das Entlassungsmanagement umfasst die Organisation und Koordination der ambulanten Versorgung und Vernetzung aller an der Versorgung beteiligten Akteure mit dem Ziel, Wiederaufnahmen zu verhindern. Über einen Zeitraum von 4 Jahren wurden 330 Familien betreut. Die Finanzierung bis zur Entlassung erfolgt durch 1) das Krankenhaus (eine Vollzeitpflegestelle), 2) die amb. Nachsorge durch Spenden, 3) und als Mitglied des Qualitätsverbundes Bunter Kreis ist sozialmedizinische Nachsorge in schweren Fällen über die Krankenkassen finanzierbar (§43, 2 SGB V).

Ergebnisse:

Die mediane Verweildauer der sehr kleinen Frühgeborenen konnte um 24 Tage verkürzt werden, die Anzahl der Fälle, über der oberen Grenzverweildauer (OGV) wurde um 64% reduziert bei gesunkener Wiederaufnahmerate Gleichzeitig konnten die Fallzahlen von 243 auf 413 gesteigert werden.

Schlussfolgerung:

Eine familienzentrierte Betreuung mit ambulanter Nachsorge steigert die Zufriedenheit der Eltern, reduziert die Aufenthaltsdauer kleiner Frühgeborener und lohnt sich daher auch aus ökonomischer Sicht.

• References

• 1 Als H. Program Guide: Newborn Individualized Developmental Care and Assessment Program (NIDCAP); An Education and Training Program for Health Care Professionals. Boston, MA: NIDCAP Federation International; 2008
  Google Scholar
• 2 Buddeberg C, Willi J. Psychosoziale Medizin. 3. Auflage Springer; 2003
  Google Scholar
• 3 Christ-Steckhan C. Elternberatung in der Neonatologie. Reinhardt, München: 2005
  CrossrefGoogle Scholar
• 4 Cooper LG, Gooding JS, Gallagher J et al. Impact of a family-centered care initiative on NICU care staff and families. J Perinatol 2007; 27: S32-S37
  CrossrefPubMedGoogle Scholar
• 5 Cox LC, Bialoskurski M. Neontal intensive care: communication and attachment. Br J Nurs 2001; 10: 668-676
  PubMedGoogle Scholar
• 6 Felderhoff-Mueser U. Newborn Individualized Developmental Care and Assessment Program (NIDCAP): Data with Controversial Evidence. Klin Padiatr 2010; 222 () 234-235
  Article in Thieme ConnectPubMedGoogle Scholar
• 7 Holditch-Davies D, Miles MS. Mothers’ stories about their experiences in the neonatal care unit. Neonatal Netw 2000; 19: 13-21
  PubMedGoogle Scholar
• 8 Huppertz-Kessler CJ, Verveur D, Poeschl J. To what degree does the NICU environment influence neurodevelopment of preterm infants?. Klin Padiatr 2010; 222 () 236-242
  Article in Thieme ConnectPubMedGoogle Scholar
• 9 Keller M, Felderhoff-Mueser U, Lagercrantz H et al. Policy benchmarking report on neonatal health and social policies in 13 European countries. Acta Paediatr Nov 2010; 99 () 1624-1629
  CrossrefPubMedGoogle Scholar
• 10 Kersting A, Dorsch M, Wesselmann U et al. Maternal posttraumatic stress response after the birth of a very low-birth-weight infant. J Psychosom Res 2004; 57 () 473-476
  CrossrefPubMedGoogle Scholar
• 11 Meijssen D, Wolf MJ, Koldewijn K et al. The effect of the Infant Behavioral Assessment and Intervention Program on mother-infant interaction after very preterm birth. J Child Psychol Psychiatry Nov 2010; 51 () 1287-1295
  CrossrefPubMedGoogle Scholar
• 12 Moll M, Schöning M, Gölz R et al. 2-year follow-up examinations (Bayley II) in infants born at <32 weeks in a German perinatal center. Klin Padiatr 2010; 223 () 251-254
  Article in Thieme ConnectPubMedGoogle Scholar
• 13 Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healty newborn infants. Cochrane Database Syst Rev 2007; () CD003519.Review
  PubMedGoogle Scholar
• 14 Nystroem K, Axelsson K. Mothers’ experience of being separated from their newborns. J Obstet Gynecol Neonatal Nurs 2002; 31: 275-282
  CrossrefPubMedGoogle Scholar
• 15 Podeswik A, Porz F, Groeger K. Sozialmedizinische Nachsorge für schwer und chronisch kranke Kinder. Monatsschr Kinderheilk 2009; 157: 129-135
  CrossrefPubMedGoogle Scholar
• 16 Singer L, Davillier M, Bruening P et al. Social support, psychological distress, and parenting strains in mothers of very preterm infants. Fam Relations 1996; 45: 343-350
  CrossrefPubMedGoogle Scholar
• 17 Spittle AJ, Anderson PJ, Lee KJ et al. Preventive care at home for very preterm Infants improves infant and caregiver outcomes at 2 years. Pediatrics 2010; 126: e171-e178
  CrossrefPubMedGoogle Scholar
• 18 Wereszczak J, Shandor Miles M, Holditch-Davies D. Maternal recall of the neonatal intensive care unit. Neonatal Netw 1997; 16: 33-40
  PubMedGoogle Scholar
• 19 Wigert H, Johansson R, Berg M et al. Mothers’ experiences of having their newborn child in a neonatal intensive care unit. Scand J Caring Sci 2006; 20: 35-41
  CrossrefPubMedGoogle Scholar
• 20 Wiedemann T. Wirtschaftlichkeit und Effektivität verbesserter ambulant-stationärer Verzahnung durch Case Management. Peter Lang, Europäischer Verlag der Wissenschaften; Frankfurt: 2005
  Google Scholar
• 21 Zaers S, Waschke M, Ehlert U. Depressive Symptoms and symptoms of post-traumatic stress disorder in women after childbirth. J Psychosom Obstet Gynaecol 2008; 29 () 61-71
  CrossrefPubMedGoogle Scholar