Impact of the Coronavirus Pandemic on High-Risk Infant Follow-Up (HRIF) Programs: A Survey of Academic Programs
Abstract
:1. Introduction
2. Methods
- (1)
- The demographics of HRIF clinics programs;
- (2)
- The effects of the pandemic on the conduct of HRIF clinics and solutions to some common problems;
- (3)
- The effects of the pandemic on the availability of personnel in the clinic and early intervention programs;
- (4)
- Changes to reimbursements and the standardization of telemedicine visits.
3. Analysis
4. Results
4.1. Program Characteristics
4.2. Impact of the Pandemic on Conditions
4.3. Innovative Approaches to Conducting Telemedicine Visits
5. Discussion
- (1)
- Programs had to decrease the frequency of clinics due to a lack of personnel and or funding.
- (2)
- As the majority of HRIF clinics switched to either a hybrid or entirely virtual model, the access to quality and affordable internet services could be one of the reasons for decreasing show rates.
- (3)
- The delivery of care, such as the basics of vitals measurements are still limited through telemedicine services.
- (4)
- A provider or parental discomfort with telemedicine visits, as there is a lack of standardization and validity of the impact on outcomes.
- (5)
- The unclear medicolegal and state rules with regard to telemedicine visits, and future consequences.
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Abbreviations
HRIF | High-Risk Infant Programs |
NICU | Neonatal Intensive Care Unit |
SARS-CoV-2 | Severe Acute Respiratory Syndrome Coronavirus 2 |
COVID-19 | Coronavirus disease 2019 |
RedCAP | Research Electronic Data Capture |
FREIDA | Fellowship and Residency Electronic Interactive Database |
ASQs | Ages and stages questionnaires |
DAYC | Development Assessment of young children |
CP | Cerebral palsy |
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High Risk Infant Programs Characteristics | ||||
---|---|---|---|---|
United States | Canada | |||
Characteristic | N | Percentage | N | Percentage |
(Number of respondents) | (Number of respondents) | |||
Institutions with more than 40 NICU beds | 59 | 86% | 5 | 100 |
(N = 51) | ||||
Median numbers of Beds in NICU | 60 (50–81) | 5 | 65 (60–70) | |
NICU admissions per year | ||||
<250 | 2 | 3.20% | - | - |
251–500 | 7 | 11.1% | - | - |
501–750 | 14 | 22.2% | 1 | 20% |
751–1000 | 24 | 38.1% | - | - |
>1000 | 16 | 25.4% | 4 | 80% |
Criteria for Referral to HRIF clinic | ||||
All discharges | 1 | 1.60% | - | 100% |
All less than 36 weeks gestation | 57 | 90% | 5 | 100% |
Genetic anomalies | 36 | 57% | 5 | 100% |
HIE | 56 | 89% | 5 | 100% |
Neurological disorder | 43 | 68% | 5 | - |
Major Malformations | 40 | 64% | - | 30% |
Others * | 31 | 49% | 3 | |
Frequency of HRIF clinic pre-pandemic | ||||
One Half-day per Week | 14 | 23% | 1 | 20% |
One full day per week | 14 | 23% | - | - |
Two full days per week | 10 | 18.5% | 1 | 20% |
More than two days per week | 21 | 35.5% | 3 | 75% |
Average Census Per HRIF clinic day | ||||
Less than 5 patients | 8 | 14% | 1 | 20% |
5–10 Patients | 28 | 47% | 3 | 75% |
10–20 Patients | 19 | 32% | 1 | 25% |
More than 20 Patients | 4 | 7% | - | - |
COVID-19 Impact on HRIF Clinic Services | ||||
---|---|---|---|---|
Characteristic | United States | Canada | ||
Any Cancellation of HRIF Clinic | N | Percentage | N | Percentage |
(Number of respondents) | (Number of respondents) | |||
No Cancellation | 19 | 30% | 1 | 20% |
For Less than 1 month | 16 | 25% | 3 | 60% |
1–3 months | 24 | 38% | 1 | 20% |
3–5 months | 3 | 5% | - | - |
>6 months | 1 | 1.60% | - | - |
Change in clinic frequency | ||||
No Change | 42 | 71% | 4 | 80% |
Decreased | 17 | 29% | 1 | 20% |
Change in Patient show rates | ||||
Increased show rates | 9 | 15% | 1 | 20% |
Decreased show rates | 25 | 42.5% | 1 | 20% |
No change | 25 | 42.5% | 3 | 60% |
Conduct of HRIF Clinic | ||||
All in person visits | 9 | 14% | - | - |
All Telemedicine | 5 | 8% | - | - |
Both in person and telemedicine | 49 | 78% | 5 | 100% |
Multidisciplinary Telemedicine Visits | ||||
Yes | 18 | 45% | 5 | 100% |
No | 15 | 37.5% | - | |
Did not answer | 7 | 17.5% | - | |
Standardization of telemedicine visits | ||||
Yes | 21 | 53% | 4 | 80% |
No | 13 | 33% | 1 | 20% |
Did not answer | 6 | 15% | - | - |
Reimbursement compared to in person visits | ||||
<50% | 4 | 10% | N/A | N/A |
50–90% | 13 | 32.5% | ||
100% | 5 | 12.5% | ||
Did not know level of reimbursements | 2 | 5% | ||
Did not answer | 16 | 40% | ||
Did payor policies affect decision to conduct telemedicine vs in person visits? | ||||
Yes, It affected to conducted more tele visits | 5 | 8.50% | N/A | N/A |
No, It did not affect | 31 | 52.5 | ||
Did not answer | 23 | 39% | ||
Program’s Perception of changes to HRIF clinic format. (Sliding scale) | ||||
Mostly negative (a score of <50) | 27 | 55% | 0 | 0% |
Mostly positive (a score of >50) | 22 | 45% | 5 | 100% |
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Panda, S.; Somu, R.; Maitre, N.; Levin, G.; Singh, A.P. Impact of the Coronavirus Pandemic on High-Risk Infant Follow-Up (HRIF) Programs: A Survey of Academic Programs. Children 2021, 8, 889. https://doi.org/10.3390/children8100889
Panda S, Somu R, Maitre N, Levin G, Singh AP. Impact of the Coronavirus Pandemic on High-Risk Infant Follow-Up (HRIF) Programs: A Survey of Academic Programs. Children. 2021; 8(10):889. https://doi.org/10.3390/children8100889
Chicago/Turabian StylePanda, Sanjeet, Rashmi Somu, Nathalie Maitre, Garrett Levin, and Ajay Pratap Singh. 2021. "Impact of the Coronavirus Pandemic on High-Risk Infant Follow-Up (HRIF) Programs: A Survey of Academic Programs" Children 8, no. 10: 889. https://doi.org/10.3390/children8100889