Predictors of caregiver satisfaction with visiting nurse home visits after NICU discharge

Abstract

Objective: High-risk infants are commonly referred to Visiting Nurse Association (VNA) agencies for post-hospitalization services after discharge from the neonatal intensive care unit (NICU). Little is known about the effectiveness and perceived benefits of routine VNA services for these infants. The objective of this study was to identify factors predictive of family satisfaction with VNA services after NICU discharge.

Study design: This is an observational study using data collected from routine quality assurance phone calls to families after NICU discharge. The setting is a single NICU at a large, urban academic medical center in Boston, MA, USA. We included all hospitalized infants discharged from the NICU from 1 January 2008 to 31 July 2014. Predictors included markers of infant biological and social risk and a survey measure of parent and nurse perceptions of parents' preparedness at discharge. The outcome was parent response to the question, 'Did you find the VNA visit helpful?' at 2 weeks post discharge.

Results: Bivariate analyses showed perceived helpfulness of VNA visits associated with low maternal parity, lower 1-min Apgar score, lower birth weight and gestational age, diagnosis of respiratory distress syndrome and intraventricular hemorrhage and low discharge readiness scores. Only low maternal parity (odds ratio (OR) 1.82, 95% confidence interval (CI) 1.35, 2.46) and birth <35 weeks' gestation (OR 1.45, 95% CI 1.15, 1.83) were significant predictors in multivariable analysis.

Conclusions: Low maternal parity and gestational age <35 weeks predicted parent satisfaction with VNA services. Referral for VNA services is common after NICU discharge. There are currently no guidelines indicating which infants and families stand to benefit most from such services. Our findings may help in developing and streamlining processes for post-hospitalization VNA service referrals for high-risk infants.