PC1058: Racial Disparities in Hospital Readmission After Discharge from a Level III Academic NICU

Purpose/Objectives: Racial and/or ethnic disparities in health outcomes for infants in the neonatal intensive care unit (NICU) are well-documented. The Neonatal Health Equity Network formed in August 2021 with an initial focus on using quality improvement (QI) methodology to eliminate these disparities. Our global aim is to achieve equitable health outcomes through optimal NICU care, standardized and sustained family support, and a family-centered plan of transition to care at home. The initial step was to define baseline healthcare utilization after NICU discharge, which illustrated dramatic disparities for high-risk ( < 32 weeks gestation or < 1500 grams) non-Hispanic Black (NHB) infants cared for in a level III NICU at an academic safety net hospital.

Design/Methods: Our SMART aim was to decrease NICU length of stay by 10% and avoidable unplanned readmissions within 30 days of NICU discharge by 20% among NHB preterm infants. We developed a key driver diagram and determined interventions (Figure), which included universal screening for social needs, family-centered discharge planning, and improving communication and handoff between inpatient and outpatient care providers. We created a unified data stream to monitor high-risk infants for healthcare utilization after NICU discharge. Infants who were discharged or transferred were monitored for readmissions to the children's hospital within 30 days and 1 year.

Results: A total of 938 high-risk infants were admitted to the NICU between 2018-2021; 860 infants (91.6%) survived to discharge (684, 79.5%) or transfer (176, 20.5%). The baseline rate of readmission within 30 days of NICU discharge was 4.8%. NHB infants had the highest rate of readmission within 30 days after NICU discharge (8.7% vs. 2.7%), more than three times higher compared to all other infants. The baseline length of NICU stay among infants readmitted within 30 days of NICU discharge was 59.6 days. NHB infants had the highest length of NICU stay (63.4 vs. 53.2 days), approximately 20% longer compared to all other infants. The most common primary diagnoses for readmission were apnea (24%), respiratory distress (18%), bronchiolitis (15%), and feeding intolerance/failure to thrive (15%). The majority of infants (>90%) readmitted within 30 days after discharge were identified to have unmet social needs based on intake social screening.

Conclusion/Discussion: Our baseline data illuminates significant disparities in readmission for high-risk NHB infants discharged from a level III NICU within an academic safety net hospital, despite longer length of NICU stay. Aligning ongoing initiatives to improve family engagement, education, and communication; provide legal advocacy through medical-legal partnership; operationalize the Neonatal Informatics Hub; and pool additional data collected through the Neonatal Health Equity Network will serve a critical role in establishing equity as a thread across QI and health services research in the Perinatal Institute, with the ultimate goal of eliminating disparities in neonatal health outcomes.