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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 31 Research Studies Displayed
Vaughn VM, Gandhi TN, Chopra V
Antibiotic overuse after hospital discharge: a multi-hospital cohort study.
Antibiotics are commonly prescribed to patients as they leave the hospital. In this study, the investigators aimed to create a comprehensive metric to characterize antibiotic overuse after discharge among hospitalized patients treated for pneumonia or urinary tract infection (UTI) and determine whether overuse varied across hospitals and conditions. The investigators concluded that antibiotic overuse after discharge was common and varied widely between hospitals.
Citation: Vaughn VM, Gandhi TN, Chopra V . Antibiotic overuse after hospital discharge: a multi-hospital cohort study. Clin Infect Dis 2020 Dec 6;73(11):e4499-e506. doi: 10.1093/cid/ciaa1372..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge
Brajcich BC, Shallcross ML, Johnson JK
Barriers to post-discharge monitoring and patient-clinician communication: a qualitative study.
This study used semi-structured interviews and focus groups to identify barriers to post-discharge monitoring and patient-clinician communication. Participants were gastrointestinal surgery patients and clinicians, with a total of 15 patients and 17 clinicians. Four themes and four barriers were identified from patient and clinician interviews and focus groups. Patient-identified barriers included education and expectation setting, technology access and literacy, availability of resources and support, and misalignment of communication preferences. Clinician-identified barriers included health education, access to clinical team, healthcare practitioner time constraints, and care team experience and consistency.
Citation: Brajcich BC, Shallcross ML, Johnson JK . Barriers to post-discharge monitoring and patient-clinician communication: a qualitative study. J Surg Res 2021 Dec;268:1-8. doi: 10.1016/j.jss.2021.06.032..
Keywords: Hospital Discharge, Clinician-Patient Communication, Care Management, Transitions of Care
Deshpande BR, McCarthy EP, Jung Y
Initiation of long-acting opioids following hospital discharge among Medicare beneficiaries.
This study investigated the incidence of long-acting opioid initiation following acute care hospitalization among a retrospective cohort of Medicare beneficiaries in 2016 who were 65 years or older, who did not have cancer or hospice care, and had not filled an opioid prescription within the preceding 90 days. Among 258,193 hospitalizations, 18.6% were associated with a claim for a new opioid prescription in the week after hospital discharge: 0.3% with both short- and long-acting opioids, 0.1% with long-acting opioids only, and 18.2% with short-acting opioids only. Most long-acting opioid prescriptions occurred with surgical patients (81.7%). Beneficiaries of long-acting opioids were younger, had a higher prevalence of diseases of the musculoskeletal and connective tissues, and had more known risk factors of opioid-related adverse events compared to patients prescribed short-acting opioids.
Citation: Deshpande BR, McCarthy EP, Jung Y . Initiation of long-acting opioids following hospital discharge among Medicare beneficiaries. J Hosp Med 2021 Dec;16(12):724-26. doi: 10.12788/jhm.3721..
Keywords: Opioids, Medication, Hospital Discharge
Barreto EF, Schreier DJ, May HP
Incidence of serum creatinine monitoring and outpatient visit follow-up among acute kidney injury survivors after discharge: a population-based cohort study.
This study evaluated the frequency of follow-up after hospital discharge among acute kidney injury (AKI) survivors. This population-based cohort study included adult residents of Olmsted County hospitalized from an episode of stage II or II AK between 2006 and 2014. Follow-up visits at 30-days, 90 days, and 1 year were included. In the 627 included AKI survivors, the cumulative incidence of a follow-up serum creatinine (SCr) level was 80%, a healthcare visit 82%, or both was 70%. At 90 days and 1 year after discharge, cumulative incidents of meeting both follow-up criteria rose to 82 and 91% respectively. Independent predictors of receiving both were not related to demographic or socioeconomic factors but to lower estimated glomerular filtration rate at discharge, higher comorbidity burden, longer length of hospitalization, and greater maximum AKI severity.
Citation: Barreto EF, Schreier DJ, May HP . Incidence of serum creatinine monitoring and outpatient visit follow-up among acute kidney injury survivors after discharge: a population-based cohort study. Am J Nephrol 2021;52(10-11):817-26. doi: 10.1159/000519375..
Keywords: Kidney Disease and Health, Hospital Discharge, Care Management, Healthcare Utilization
Choe AY, Schondelmeyer AC, Thomson J
Improving discharge instructions for hospitalized children with limited english proficiency.
Research was conducted on an intervention for patients with limited English proficiency (LEP) who are discharged from the hospital without instructions in their preferred language. The objective was to increase the percentage of patients with LEP on the hospital medicine service who received translated discharge instructions from 12% to 80%. During the 18-month study period 540 patients with LEP were discharged. Spanish was the preferred language of 66% of these patients. The percentage of patients who received translated discharge instructions increased from 12% to 50% in 3 months, and to 77% in 18 months. For Spanish-language patients, the percentage increased to 96% by 18 months.
AHRQ-funded; HS026763; HS025138.
Citation: Choe AY, Schondelmeyer AC, Thomson J . Improving discharge instructions for hospitalized children with limited english proficiency. Hosp Pediatr 2021 Nov;11(11):1213-22. doi: 10.1542/hpeds.2021-005981.
AHRQ-funded; HS026763; HS025138..
AHRQ-funded; HS026763; HS025138..
Keywords: Children/Adolescents, Hospital Discharge, Clinician-Patient Communication, Cultural Competence, Communication
Parikh K, Richmond M, Lee M
Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma.
The purpose of this study was to evaluate a multi-component hospital-to-home (H2H) transition program for children hospitalized with an asthma exacerbation. A pilot prospective randomized clinical trial of guideline-based asthma care with and without a patient-centered multi-component H2H program was conducted among children enrolled in K-8(th) grade on Medicaid hospitalized for an asthma exacerbation. The investigators concluded that the pilot data suggested that comprehensive care coordination initiated during the inpatient stay was feasible and acceptable.
Citation: Parikh K, Richmond M, Lee M . Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma. J Asthma 2021 Oct;58(10):1384-94. doi: 10.1080/02770903.2020.1795877..
Keywords: Children/Adolescents, Patient-Centered Healthcare, Transitions of Care, Asthma, Hospital Discharge, Care Coordination, Chronic Conditions
Holler E, Meagher AD, Ortiz D
Preinjury functional independence is not associated with discharge location in older trauma patients.
This study’s purpose was to evaluate the association between pre-injury Katz Index of Independence in Activities of Daily Living (Katz ADL) functional status and discharge to a facility in non-neurologically injured trauma patients. Data from 207 subjects in the Trauma Medical Home study cohort was obtained. Patients were predominantly white (89.4%) and female (52.2%). The most common trauma injury was a fall (48.3%), followed by automobile crash (41.1%). There was no relationship between pre-injury independence and the likelihood of discharge home. Over half of patients (51.7%) were discharged home, 37.7% to subacute rehabilitation., 10.1% to acute rehabilitation, and 0.5% to long-term acute care. Patients who self-reported depression and anxiety who weren’t sent home was associated with age, being single, and being female.
Citation: Holler E, Meagher AD, Ortiz D . Preinjury functional independence is not associated with discharge location in older trauma patients. J Surg Res 2021 Oct;266:413-20. doi: 10.1016/j.jss.2021.04.029..
Keywords: Elderly, Trauma, Hospital Discharge
Herzig SJ, Anderson TS, Jung Y
Relative risks of adverse events among older adults receiving opioids versus NSAIDs after hospital discharge: a nationwide cohort study.
This retrospective cohort study’s objective was to determine the incidence and risk of post-discharge adverse events among opioid claims in the week after hospital discharge, compared to those with nonsteroidal anti-inflammatory drugs (NSAIDs) claims alone. A national sample of Medicare beneficiaries age 65 and older who were hospitalized in the United States in 2016 was used. Beneficiaries who were admitted from or discharged to a facility were excluded. The authors used 3:1 propensity matching to match beneficiaries with an opioid claim in the week after discharge (13,385) with beneficiaries with NSAID claim alone (4,677). Beneficiaries receiving opioids had a higher incidence of death, healthcare utilization, and any potential adverse effect compared to those with an NSAID claim only. Specific adverse effects included higher relative risk of fall/fracture, nausea/vomiting, and slowed colonic motility.
Citation: Herzig SJ, Anderson TS, Jung Y . Relative risks of adverse events among older adults receiving opioids versus NSAIDs after hospital discharge: a nationwide cohort study. PLoS Med 2021 Sep 27;18(9):e1003804. doi: 10.1371/journal.pmed.1003804..
Keywords: Elderly, Opioids, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Risk, Hospital Discharge
Siddique SM, Tipton K, Leas B
Interventions to reduce hospital length of stay in high-risk populations: a systematic review.
Many strategies to reduce hospital length of stay (LOS) have been implemented, but few studies have evaluated hospital-led interventions focused on high-risk populations. The Agency for Healthcare Research and Quality (AHRQ) Learning Health System panel commissioned this study to further evaluate system-level interventions for LOS reduction. The objective of this study was to identify and synthesize evidence regarding potential systems-level strategies to reduce LOS for patients at high risk for prolonged LOS.
Citation: Siddique SM, Tipton K, Leas B . Interventions to reduce hospital length of stay in high-risk populations: a systematic review. JAMA Netw Open 2021 Sep;4(9):e2125846. doi: 10.1001/jamanetworkopen.2021.25846..
Keywords: Learning Health Systems, Healthcare Systems, Evidence-Based Practice, Hospital Discharge, Risk, Inpatient Care, Care Management
Manges KA, Ayele R, Leonard C
Differences in transitional care processes among high-performing and low-performing hospital-SNF pairs: a rapid ethnographic approach.
This study’s objective was to explore differences between low- and high-performing hospitals and skilled nursing facilities (SNFs) pairs and postacute care outcomes. The authors used flow maps and thematic analysis to describe the process of hospitals discharging patients to SNFs and to identify differences in subprocesses used by high-performing and low-performing hospitals. Hospitals were classified based on their 30-day readmission rates from SNFs. The final sample included 148 hours of observations with 30 clinicians across four hospitals and five corresponding SNFs. High-performing sites differed in each stage from low-performing sites by focusing on 1) earlier, ongoing, systematic identification of high-risk patients; 2) discussing the decision to go to an SNF as an iterative team-based process and 3) anticipating barriers with knowledge of transitional and SNF care processes.
Citation: Manges KA, Ayele R, Leonard C . Differences in transitional care processes among high-performing and low-performing hospital-SNF pairs: a rapid ethnographic approach. BMJ Qual Saf 2021 Aug;30(8):648-57. doi: 10.1136/bmjqs-2020-011204..
Keywords: Transitions of Care, Hospitals, Nursing Homes, Hospital Readmissions, Hospital Discharge
Orenstein EW, ElSayed-Ali O, Kandaswamy S
Evaluation of a clinical decision support strategy to increase seasonal influenza vaccination among hospitalized children before inpatient discharge.
The authors’ goal was to design and evaluate a clinical decision support (CDS) strategy to increase the proportion of eligible hospitalized children who receive a seasonal influenza vaccine prior to inpatient discharge. They found that a user-centered CDS may be associated with significantly improved influenza vaccination rates among hospitalized children.
Citation: Orenstein EW, ElSayed-Ali O, Kandaswamy S . Evaluation of a clinical decision support strategy to increase seasonal influenza vaccination among hospitalized children before inpatient discharge. JAMA Netw Open 2021 Jul;4(7):e2117809. doi: 10.1001/jamanetworkopen.2021.17809..
Keywords: Children/Adolescents, Influenza, Vaccination, Clinical Decision Support (CDS), Health Information Technology (HIT), Hospital Discharge
Manges KA, Wallace AS, Groves PS
Ready to go home? Assessment of shared mental models of the patient and discharging team regarding readiness for hospital discharge.
A critical task of the inpatient interprofessional team is readying patients for discharge. Assessment of shared mental model (SMM) convergence can determine how much team members agree about patient discharge readiness and how their mental models align with the patient's self-assessment. The objective of this study was to determine the convergence of interprofessional team SMMs of hospital discharge readiness and identify factors associated with these assessments.
Citation: Manges KA, Wallace AS, Groves PS . Ready to go home? Assessment of shared mental models of the patient and discharging team regarding readiness for hospital discharge. J Hosp Med 2021 Jun;16(6):326-32. doi: 10.12788/jhm.3464..
Keywords: Hospital Discharge, Teams, Care Management, Decision Making, Hospitals
Popejoy LL, Vogelsmeier AA, Wang Y
Testing re-engineered discharge program implementation strategies in SNFs.
This paper describes a trial of the redesigned Re-Engineered Discharge (RED) program, which was originally designed for hospitals, for use at skilled nursing facilities (SNFs). This tool’s objective is to reduce rehospitalizations after discharge. Two different RED implementation strategies (Enhanced and Standard) were compared pretest-posttest. The Standard group had higher odds of being readmitted in the pre-intervention versus post-intervention program. After adjusting coefficients using Poisson regression, the adjusted number of hospitalizations in the Standard group was 45% higher at 30 days, 50% higher at 60 days, and 39% higher at 180 days.
Citation: Popejoy LL, Vogelsmeier AA, Wang Y . Testing re-engineered discharge program implementation strategies in SNFs. Clin Nurs Res 2021 Jun;30(5):644-53. doi: 10.1177/1054773820982612..
Keywords: Hospital Discharge, Hospital Readmissions, Implementation, Hospitals
Costello WG, Zhang L, Schnipper J
Post-discharge adverse events among African American and Caucasian patients of an urban community hospital.
This study compared post-discharge adverse events (AEs) among African American and Caucasian patients at an urban community hospital. This prospective cohort study was conducted from December 2011 to October 2012. The cohort included 589 English-speaking patients who were discharged home and could be contacted after discharge for evaluation. Two nurses performed 30-day post-discharge telephone interviews, and two physicians reviewed health records to determine AEs using a previous methodology. African Americans had a slightly higher incidence of post-discharge AEs than Caucasian patients (30.6 vs. 29.9%) but it was not statistically significant.
Citation: Costello WG, Zhang L, Schnipper J . Post-discharge adverse events among African American and Caucasian patients of an urban community hospital. J Racial Ethn Health Disparities 2021 Apr;8(2):439-47. doi: 10.1007/s40615-020-00800-z..
Keywords: Adverse Events, Racial / Ethnic Minorities, Urban Health, Disparities, Hospital Discharge
Dalal AK, Piniella N, Fuller TE
Evaluation of electronic health record-integrated digital health tools to engage hospitalized patients in discharge preparation.
Researchers sought to evaluate the effect of electronic health record (EHR)-integrated digital health tools comprised of a checklist and video on transitions-of-care outcomes for patients preparing for discharge. They found that EHR-integrated digital health tools to prepare patients for discharge did not significantly increase patient activation and was associated with a longer length of stay.
Citation: Dalal AK, Piniella N, Fuller TE . Evaluation of electronic health record-integrated digital health tools to engage hospitalized patients in discharge preparation. J Am Med Inform Assoc 2021 Mar 18;28(4):704-12. doi: 10.1093/jamia/ocaa321..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Hospital Discharge, Patient and Family Engagement, Education: Patient and Caregiver
Misra-Hebert AD, Rothberg MB, Fox J
Healthcare utilization and patient and provider experience with a home visit program for patients discharged from the hospital at high risk for readmission.
This retrospective cohort study assessed the association of home visits by advanced practice registered nurses (APRNs) and paramedics with healthcare utilization and mortality of patients released home after hospital discharge The authors looked at adult medical patients discharged to home from November 2017-September 2019. They assessed outcomes for home visit vs. matched comparison patients at 30, 90, and 180 days, including hospital admission, emergency department (ED) use, and death using two phases. Phase 1 was defined as APRN or paramedic visits assigned by geographic location and Phase 2 defined as APRN and paramedic visit teams assigned to patients. They also compared patients who declined home visits with those accepting them. Phase 1 outcomes showed no differences in readmissions, ED visits, or death at 30,90, and 180 days. Phase 2 showed patients who had home visits had fewer 30-day readmissions and no differences in other outcomes. Patients who accepted home visits had lower odds of readmission compared to patients who declined. Forty-four interviews were also conducted, and themes of Medication Understanding, Knowledge Gap after Discharge, Patient Medical Complexity, Social Context, and Patient Engagement/Need for Reassurance emerged.
Citation: Misra-Hebert AD, Rothberg MB, Fox J . Healthcare utilization and patient and provider experience with a home visit program for patients discharged from the hospital at high risk for readmission. Healthc 2021 Mar;9(1):100518. doi: 10.1016/j.hjdsi.2020.100518..
Keywords: Home Healthcare, Transitions of Care, Hospital Discharge, Hospital Readmissions
Ye S, Hiura G, Fleck E
Hospital readmissions after implementation of a discharge care program for patients with COVID-19 illness.
The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity. The objective of this study was to determine whether lenient provisional discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness. The investigators found that lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic.
AHRQ-funded; HS024262; HS025198.
Citation: Ye S, Hiura G, Fleck E . Hospital readmissions after implementation of a discharge care program for patients with COVID-19 illness. J Gen Intern Med 2021 Mar;36(3):722-29. doi: 10.1007/s11606-020-06340-w..
Keywords: COVID-19, Hospital Discharge, Hospital Readmissions, Hospitals, Public Health, Hospitalization, Risk
Puebla Neira DA, Hsu ES, Kuo YF
Readmissions reduction program: mortality and readmissions for chronic obstructive pulmonary disease.
Implementation of the Hospital Readmissions Reduction Program (HRRP) following discharge of patients with chronic obstructive pulmonary disease (COPD) has led to a reduction in 30-day readmissions with unknown effects on postdischarge mortality. The objective of this retrospective cohort study was to examine the association of HRRP with 30-day hospital readmission and 30-day postdischarge mortality rate in patients after discharge from COPD hospitalization.
Citation: Puebla Neira DA, Hsu ES, Kuo YF . Readmissions reduction program: mortality and readmissions for chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2021 Feb 15;203(4):437-46. doi: 10.1164/rccm.202002-0310OC..
Keywords: Hospital Readmissions, Respiratory Conditions, Chronic Conditions, Mortality, Hospital Discharge, Hospitalization
Gonzalez MR, Junge-Maughan L, Lipsitz LA
ECHO-CT: an interdisciplinary videoconference model for identifying potential postdischarge transition-of-care events.
In this paper, data collected through the Extension for Community Health Outcomes- Care Transitions (ECHO-CT) model were used to identify and classify transition-of-care events (TCEs). Findings showed that the TCEs identified highlight areas in which providers can work to reduce issues arising during the course of discharge to post-acute care facilities. Recommendations included standardized processes to identify, record, and report TCEs in order to provide high-quality, safe care for patients as they move across care settings.
Citation: Gonzalez MR, Junge-Maughan L, Lipsitz LA . ECHO-CT: an interdisciplinary videoconference model for identifying potential postdischarge transition-of-care events. J Hosp Med 2021 Feb;16(2):93-96. doi: 10.12788/jhm.3523..
Keywords: Transitions of Care, Hospital Discharge, Quality Improvement, Quality of Care
Donnelly JP, Wang XQ, Iwashyna TJ
Readmission and death after initial hospital discharge among patients with COVID-19 in a large multihospital system.
This study describes reasons for readmission, use of intensive care unit (ICU) interventions during readmission, and proportions of death after initial hospital discharge of COVID-19 patients from US Veterans Affairs (VA) hospitals March-June 2020.
Citation: Donnelly JP, Wang XQ, Iwashyna TJ . Readmission and death after initial hospital discharge among patients with COVID-19 in a large multihospital system. JAMA 2021 Jan 19;325(3):304-06. doi: 10.1001/jama.2020.21465.
Keywords: Respiratory Conditions, COVID-19, Hospital Readmissions, Hospital Discharge, Mortality, Outcomes, Veterans
Sanger PC, Hartzler A, Han SM
Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution.
This study explored patient experience of surgical site infections (SSI) and openness to a mobile health (mHealth) wound monitoring ‘‘app’’ as a novel solution to address the problem of patient perceptions about barriers experienced while seeking care for post-discharge SSI. It found that patients are dissatisfied with the current standard post-hospitalization care practice and were accepting of the concept of a patient-centered wound monitoring application.
Citation: Sanger PC, Hartzler A, Han SM . Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution. PLoS One 2014 Dec;9(12):e114016. doi: 10.1371/journal.pone.0114016..
Keywords: Surgery, Health Information Technology (HIT), Adverse Events, Patient Experience, Hospital Discharge
Sanger P, Hartzler A, Lober WB
Design considerations for post-acute care mHealth: patient perspectives.
The authors are developing an mHealth platform to engage patients in wound tracking to identify and manage surgical site infections (SSI) after hospital discharge. Their key design qualities include: meeting basic accessibility, usability and security needs; encouraging patient-centeredness; facilitating better, more predictable communication; and supporting personalized management by providers. In this article, they illustrated their application of these guiding design considerations and proposed a new framework for mHealth design based on illness duration and intensity.
Citation: Sanger P, Hartzler A, Lober WB . Design considerations for post-acute care mHealth: patient perspectives. AMIA Annu Symp Proc 2014 Nov 14;2014:1920-9.
Keywords: Telehealth, Patient Self-Management, Surgery, Injuries and Wounds, Healthcare-Associated Infections (HAIs), Hospital Discharge, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Adverse Events
Albrecht JS, Gruber-Baldini AL, Hirshon JM
Hospital discharge instructions: comprehension and compliance among older adults.
The purpose of this prospective cohort study was to quantify the prevalence of non-comprehension and non-compliance with discharge instructions and to identify associated patient characteristics. The investigators concluded that non-comprehension of discharge instructions among older adults was prevalent, multi-factorial, and varies by domain.
Citation: Albrecht JS, Gruber-Baldini AL, Hirshon JM . Hospital discharge instructions: comprehension and compliance among older adults. J Gen Intern Med 2014 Nov;29(11):1491-8. doi: 10.1007/s11606-014-2956-0..
Keywords: Elderly, Health Literacy, Hospital Discharge, Patient Adherence/Compliance
Goldman LE, Sarkar U, Kessell E
Support from hospital to home for elders: a randomized trial.
The researchers studied a peridischarge, nurse-led intervention combined with telephone follow-up designed to reduce readmissions among patients who were 55 or older. They found that the nurse-led, in-hospital discharge support intervention did not show a reduction in readmissions or ED visits among 700 diverse, low-income older adults at a safety-net hospital.
Citation: Goldman LE, Sarkar U, Kessell E . Support from hospital to home for elders: a randomized trial. Ann Intern Med 2014 Oct 7;161(7):472-81. doi: 10.7326/m14-0094..
Keywords: Hospital Discharge, Hospital Readmissions, Emergency Department, Elderly, Social Determinants of Health, Nursing
Garfield CF, Lee Y, Kim HN
Paternal and maternal concerns for their very low-birth-weight infants transitioning from the NICU to home.
The authors examined the concerns and coping mechanisms of fathers and mothers of very low-birth-weight neonatal intensive care unit (NICU) infants as they transition to home from the NICU. They found that overriding concerns included pervasive uncertainty, lingering medical concerns, and partner-related adjustment concerns that differed by gender. They concluded that many parental concerns can be addressed with improved discharge information exchanges and anticipatory guidance.
Citation: Garfield CF, Lee Y, Kim HN . Paternal and maternal concerns for their very low-birth-weight infants transitioning from the NICU to home. J Perinat Neonatal Nurs 2014 Oct-Dec;28(4):305-12. doi: 10.1097/jpn.0000000000000021.
Keywords: Care Coordination, Hospital Discharge, Neonatal Intensive Care Unit (NICU), Newborns/Infants, Transitions of Care