Neonatal CATCH Program: Remote Monitoring Benefits Medically Complex Infants at Home.
Abstract
Background
Medically complex infants comprise a small fraction of births yet account for disproportionate health care utilization after neonatal intensive care unit (NICU) discharge. We evaluated a 30-day postdischarge remote patient management (RPMT) program-Neonatal Collaborative Assistance and Telehealth for Complex Homecare (CATCH)-combining remote therapeutic monitoring and structured caregiver support.
Methods
In a pragmatic, staged rollout (March 2023 to February 2025), we prospectively followed eligible NICU graduates discharged on tube feeds, yielding two cohorts: enrolled (E) and not enrolled (NE), plus a historical "would-have-been-eligible" cohort. Interventions included telemedicine visits, bidirectional text message check-ins, and collaboration with primary and subspecialty care teams. Outcomes were 30-day readmission (RA30), 30-day ED visit (EDV30), frequency and types of interventions, Net Promoter Score, and weight gain. Analyses used statistical process control (SPC) methods, bivariate tests, and logistic regression modeling.
Results
Three hundred and two and 254 infants were, respectively, E and NE during CATCH implementation, plus 853 historical controls for a total of 1,409 eligible infants. Mean weight gain did not differ (18.8 vs. 22.3 g; p = 0.28). RA30 was lower in E versus NE (13% vs. 22%; p < 0.01), and EDV30 was lower in E versus NE (21% vs. 28%; p = 0.08). Regression and inferential statistics provided a deeper understanding, complemented by SPC time charts that included comparison with historical cohort. At least one "good catch" intervention occurred in 23% of enrolled infants with the majority closing communication gaps among health care team members; net promoter score was 89.
Conclusions
A structured RPMT program immediately after NICU discharge was associated with lower 30-day readmissions, beneficial interventions, and was highly recommended by families. Future studies and actions must address social determinants such as interpreter access.