Utilization of care by infants with neonatal abstinence syndrome in Delaware

Introduction: There is little information regarding use of expected well care by infants diagnosed with neonatal abstinence syndrome (NAS) post initial discharge. We describe expected and unexpected utilization of care by infants with NAS in the first year of life. Methods: A de-identified State of Delaware Medicaid data set was obtained. Included were all infants with an ICD-9 code for NAS from 01/01/2012-12/31/2014. All associated medical claims were extracted for one year after birth. Utilization rates of primary care, immunizations, urgent or emergency care, and re-hospitalization were quantified. Results: 499 of 522 babies were able to be fully analyzed. The population reflected Delaware demographics. Fifteen percent were preterm. Attendance at expected well visits ranged from 65% at two months to 30% at nine months. This is less than published rates for Medicaid infants as a whole. Two percent had no well visit. Immunization rates were below national average at 92%. Urgent care use was 7%, Emergency Department 52% and inpatient re-admission 15%. General term re-admission rates have has described at less than 10%. Conclusion: There is a decreased amount of well child visits and immunization rates in infants diagnosed with NAS. This represents a loss of preemptive care, developmental screening and early intervention. Engagement in primary care may decrease the need for urgent and emergency room care. Future research should include prospective analysis of utilization with case management focus, and collaboration with community partners. Real-time surveillance would inform planning and decision making for programming and allocation of resources.https://jdc.jefferson.edu/nursingposters/1016/thumbnail.jp