Send Orders for Reprints to reprints@benthamscience.ae 39 1874-3064/18 2018 Bentham Open The Open Respiratory Medicine Journal Content list available at: www.benthamopen.com/TORMJ/ DOI: 10.2174/1874306401812010039, 2018, 12, 39-49 RESEARCH ARTICLE The Effect of Comprehensive Medical Care on the Long-Term Outcomes of Children Discharged from the NICU with Tracheostomy Wilfredo De Jesus-Rojas 1,* , Ricardo A. Mosquera 1 , Cheryl Samuels 2 , Julie Eapen 2 , Traci Gonzales 2 , Tomika Harris 2 , Sandra McKay 2 , Fatima Boricha 2 , Claudia Pedroza 1 , Chiamaka Aneji 3 , Amir Khan 3 , Cindy Jon 1 , Katrina McBeth 1 , James Stark 1 , Aravind Yadav 1 and Jon E. Tyson 3 1 Division of Pulmonary Medicine/Allergy & Immunology/Rheumatology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA 2 High-Risk Children’s Clinic, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA 3 Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA Received: March 29, 2018 Revised: May 6, 2018 Accepted: June 21, 2018 Abstract: Background: Survival of infants with complex care has led to a growing population of technology-dependent children. Medical technology introduces additional complexity to patient care. Outcomes after NICU discharge comparing Usual Care (UC) with Comprehensive Care (CC) remain elusive. Objective: To compare the outcomes of technology-dependent infants discharged from NICU with tracheostomy following UC versus CC. Methods: A single site retrospective study evaluated forty-three (N=43) technology-dependent infants discharged from NICU with tracheostomy over 5½ years (2011-2017). CC provided 24-hour accessible healthcare-providers using an enhanced medical home. Mortality, total hospital admissions, 30-days readmission rate, time-to-mechanical ventilation liberation, and time-to-decannulation were compared between groups. Results: CC group showed significantly lower mortality (3.4%) versus UC (35.7%), RR, 0.09 [95%CI, 0.12-0.75], P=0.025. CC reduced total hospital admissions to 78 per 100 child-years versus 162 for UC; RR, 0.48 [95% CI, 0.25-0.93], P=0.03. The 30-day readmission rate was 21% compared to 36% in UC; RR, 0.58 [95% CI, 0.21-1.58], P=0.29). In competing-risk regression analysis (treating death as a competing-risk), hazard of having mechanical ventilation removal in CC was two times higher than UC; SHR, 2.19 [95% CI, 0.70-6.84]. There was no difference in time-to-decannulation between groups; SHR, 1.09 [95% CI, 0.37-3.15]. Conclusion: CC significantly decreased mortality, total number of hospital admissions and length of time-to-mechanical ventilation liberation. Keywords: Decannulation, Tracheostomy, Complex-care, Mortality, Comprehensive-care, Usual-care. * Address correspondence to this author at the Division of Pulmonary Medicine/Allergy & Immunology/Rheumatology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin Street, MSB 3.228 Houston, TX, USA 77030; E-mail: Wilfredo.DeJesusRojas@uth.tmc.edu