Neonatologists at Children’s Hospital Los Angeles cared for 4,100 of the system’s tiniest patients—some weighing only a few pounds—and their mothers last fiscal year.
Those patients were high-risk infants born prematurely, at low birth weight or with complex conditions, requiring treatment in neonatal intensive-care units and, for those at risk for developmental issues, ongoing follow-up care.
That follow-up care, provided through a screening program called the Newborn Follow-Up Program, has helped to improve health and neuro-developmental outcomes for high-risk infants through personalized discharge plans and referring parents to specialists and community resources.
But those discharge plans can prove complicated, including such steps as coordinating early intervention services, attending additional physician visits and purchasing expensive medical equipment—particular challenges for low-income and underserved populations, said Dr. Ashwini Lakshmanan, a neonatologist at Children’s Hospital Los Angeles. “Parents are really tasked with doing a lot for these children,” Lakshmanan said. “It’s a huge ask, on their part, to organize all of this and make it happen.”
That’s why, about a year ago, she and Michele Kipke, vice chair of research in the hospital’s pediatrics department, decided to develop and test a virtual transition-to-home program, to be distributed to patients via an app.
The app, Baby Steps LA, grew out of a series of interviews and focus groups the hospital held with parents of high-risk infants about challenges they encountered after returning home from the NICU. “One of the themes that emerged over and over again was the need for a mobile health solution” that packages education, planning and support in one place, Lakshmanan said.
The app provides much of the same information that parents would receive at in-person transition-to-home programs like the Newborn Follow-Up Program, but available from their phone 24/7. That can mean videos on medical care as well as support for social determinants of health—including information on transportation or how to apply for benefits through the Supplemental Security Income program.
Baby Steps LA also builds on the Newborn Follow-Up Program by providing a central place for parents to access their baby’s transition-to-home curriculum, including information about their diagnosis, care team, prescribed medications and task lists in English and Spanish. Parents can also participate in an online support group through the app.
The app presents a possible solution to one of the core challenges that new parents experience when caring for a high-risk infant: care coordination.
“There’s often the need for more care or monitoring than you would have in an otherwise healthy baby or following a typical birth,” said Dr. Michael Warren, associate administrator at the maternal and child health bureau, part of HHS’ Health Resources and Services Administration. He said that the gold standard for postnatal care is for every high-risk infant to have a “medical home,” a practice that’s focused on comprehensive primary care and care coordination.
Children’s Hospital Los Angeles, which began piloting the app this summer, was named a winner of the American Hospital Association’s 2019 Innovation Challenge for Baby Steps LA in July. The hospital was awarded $15,000 in the hopes that the app will be able to improve health equity among underserved populations.
For the challenge, a panel of judges selected three winners based on criteria like advancing the Triple Aim, leveraging innovative technology and supporting community partnerships.
“It’s using technology to give people easier access to information,” Lori Dennis, one of the judges on the challenge and senior vice president at First American Agenball Money, said of Baby Steps LA. First American is a leasing and financing solutions provider that sponsored the AHA Innovation Challenge.
It’s too early to tell if the app’s proactive approach will prove effective for preventive care. But while virtual transition-to-home programs haven’t been thoroughly studied, in-person ones have been linked with cutting readmissions and contributing Medicaid savings of more than $4,000 per infant per quarter, according to a study published last year in the Journal of Pediatrics.
By offering similar types of services virtually, “we hope we might see something similar with the app,” Lakshmanan said.