TY - JOUR
T1 - Development and nationwide implementation of a postdischarge responsive parenting intervention program for very preterm born children
T2 - The TOP program
AU - Jeukens-Visser, Martine
AU - Koldewijn, Karen
AU - van Wassenaer-Leemhuis, Aleid G
AU - Flierman, Monique
AU - Nollet, Frans
AU - Wolf, Marie-Jeanne
N1 - Funding Information: For full implementation, the TOP program needed to be included in the basic package of Dutch Health Care Insurers, making the program available for all infants without charge. To obtain approval of the DHA and financial support from the Health Care Insurers, we needed to show that the TOP program was feasible, acceptable, and cost‐effective in a real‐world setting. Therefore, a second BC, based on process and outcome measures of the pilot implementation phase (2010–2013) of the TOP program, was written. The aim of our second economic evaluation was to show the efficiency of the implementation of the TOP program in terms of better healthcare outcomes for the infants. Data collected from 115 infants, who were supported by the TOP program during the pilot implementation phase of the TOP program, were compared to historic data from 129 infants who had received routine care, which included standard neonatal follow‐ups and referrals when necessary but did not include a postdischarge intervention program. These 129 infants were 78 infants in the control group of the RCT as well as retrospective data of 51 VPT infants who were admitted to a regional hospital in Amsterdam in 2008. Healthcare utilization was reduced for infants who were supported by the TOP program. Infants in the TOP program received less paramedical support after the intervention had ended (11% in the TOP program vs. 22% in the routine care group), had fewer hospital readmissions (17% vs. 40%), fewer visits to the Emergency Department (20.4% vs. 29.4%), and less reports of child abuse during the first year of life (0.8% vs. 6.4%). Overall, the TOP program showed considerable savings in respect of child health care, combined with better well‐being of the infants at 12 months. The second BC was submitted to the DHA with a request to approve sustainable funding by the Health Care Insurers for the TOP program. Different funding pathways were explored. Feasible funding was accomplished in a bundled payment in terms of which the cost of the TOP program's intervention visits and overhead was included in a package price. After consultation with the DHA and the Dutch Healthcare Insurers, this bundled payment was approved, provided that care performances were described in detail. Therefore, from 2014 onward, the TOP program was included in the basic health insurance package and was available for the total Dutch target population. Overheads per infant were calculated for the management of the organization, including financial management, systematic evaluation and monitoring, quality assurance, and information provision. The rate for the overhead module decreases gradually when the number of children in the program increases. The intervention module included 33.5 hr per family for a year (12 home visits with written reports after each visit, travel costs, and hours for parental coaching). The rate for the intervention module was indexed annually. Publisher Copyright: © 2020 The Authors. Infant Mental Health Journal published by Wiley Periodicals LLC on behalf of Michigan Association for Infant Mental Health
PY - 2021/5/1
Y1 - 2021/5/1
N2 - A previous randomized controlled trial has suggested the effectiveness of a Dutch postdischarge responsive parenting program for very preterm (VPT) infants, indicating that nationwide implementation was justified. This paper describes the development and nationwide implementation of the intervention, known as the TOP program, which consisted of three phases. In the preparation phase (2006-2010), a theory of change and the structure of the TOP program were developed, and funding for phase two, based on a positive Business Case, was obtained. In the pilot implementation phase (2010-2014), intervention strategies were developed for a real-world setting, capacity and adoption were increased, systematic evaluations were incorporated, and sustained funding was obtained. In the full-implementation phase (2014-2019), all Dutch Healthcare Insurers reimbursed the TOP program, enabling VPT infants to participate in the program without charge. By 2018, the number of interventionists that provided the TOP program had increased from 37 to 91, and all level III hospitals and 65% of regional hospitals in the Netherlands referred VPT infants. Currently, the program reaches 70% of the Dutch target population and parental satisfaction with the TOP program is high. After a 12-year implementation period, the TOP program forms part of routine care in the Netherlands.
AB - A previous randomized controlled trial has suggested the effectiveness of a Dutch postdischarge responsive parenting program for very preterm (VPT) infants, indicating that nationwide implementation was justified. This paper describes the development and nationwide implementation of the intervention, known as the TOP program, which consisted of three phases. In the preparation phase (2006-2010), a theory of change and the structure of the TOP program were developed, and funding for phase two, based on a positive Business Case, was obtained. In the pilot implementation phase (2010-2014), intervention strategies were developed for a real-world setting, capacity and adoption were increased, systematic evaluations were incorporated, and sustained funding was obtained. In the full-implementation phase (2014-2019), all Dutch Healthcare Insurers reimbursed the TOP program, enabling VPT infants to participate in the program without charge. By 2018, the number of interventionists that provided the TOP program had increased from 37 to 91, and all level III hospitals and 65% of regional hospitals in the Netherlands referred VPT infants. Currently, the program reaches 70% of the Dutch target population and parental satisfaction with the TOP program is high. After a 12-year implementation period, the TOP program forms part of routine care in the Netherlands.
KW - implementation
KW - intervention reach
KW - parental satisfaction
KW - responsive parenting intervention
KW - very preterm infants
UR - http://www.scopus.com/inward/record.url?scp=85097775201&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/imhj.21902
DO - https://doi.org/10.1002/imhj.21902
M3 - Article
C2 - 33336859
SN - 0163-9641
VL - 42
SP - 423
EP - 437
JO - Infant Mental Health Journal
JF - Infant Mental Health Journal
IS - 3
ER -