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Systematic Changes to Help Parentsof Medically Complex Infants Manage Medical Expenses

Carter, Judith RN, CCRN; Dwyer, Noel MBA, RN, CCRN; Roselund, Julie AS; Cote, Karen MSN, RN; Chase, Phoebe MSW, LICSW; Martorana, Kathleen RN, CCRN; Gustafson, Kathryn BSN, RN, CCRN; Bergling, Emily MPH; Kamalia, Radhika MPH; DeGrazia, Michele PhD, RN, NNP-BC, FAAN

Section Editor(s): Forsythe, Paula L.

doi: 10.1097/ANC.0000000000000447
Outcomes of Neonatal Care

Background: Financial obligations serve as an added source of stress and burden for parents of medically complex infants that have extended hospitalizations in the neonatal intensive care unit. Financial resources and support personnel are available to assist parents, but systems must be in place to help access these services. When neonatal intensive care unit nurses work collaboratively with financial support personnel, they improve families' access to financial resources.

Purpose: The purpose of this quality improvement initiative was to increase and facilitate timely parent referrals to health benefits coordinators (HBCs).

Methods/Search Strategy: Utilizing the Plan-Do-Study Act framework, the hospital's current system for HBC referrals was revised utilizing 3 Plan-Do-Study Act cycles.

Findings/Results: A substantial increase in the percentage of HBC referrals, from preimplementation of less than 5% to a sustained average of 90% was observed.

Implications for Practice: A simple, sustainable screening process was successfully created to identify families with primary health insurance who qualified for coordination of benefits. This resulted in a significant increase in the number of HBC referrals. Minimal time is now required for the multidisciplinary team to ensure that parents, eligible for referral, are identified as soon as possible. Early identification and timely referral to the HBC may lessen the financial burden for families caring for children with medically complex long-term care needs by securing secondary insurance and other resources.

Implications for Research: Research focused on the financial impact of the HBC role is needed.

Neonatal Intensive Care Unit (Mss Carter, Dwyer, Cote, Chase, Martorana, and Gustafson and Dr DeGrazia), Cardiovascular and Critical Care Services (Ms Bergling), and Department of Medicine Quality Program (Ms Kamalia), Boston Children's Hospital, Boston, Massachusetts; and Enhanced Coordination of Benefits, University of Massachusetts Medical School, Shrewsbury (Ms Roselund).

Correspondence: Judith Carter, RN, CCRN, Neonatal Intensive Care Unit-7 North, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (

This project was supported by unit and institutional-based resources.

The authors declare no conflicts of interest.

© 2017 by The National Association of Neonatal Nurses