The FICare model was originally developed by a team of doctors, nurses, parents and other health professionals at Mount Sinai Hospital in Toronto.
Our group has conducted and published the results of a pilot study investigating the impact of FICare on infants and parents. The study is summarized below. We are currently carrying out a randomized controlled trial investigating outcomes observed under the FICare model in 19 Canadian, 6 Australian and 1 New Zealand NICUs (13 intervention sites, 13 control sites; details below).
Pilot Study Details *
Pilot start date: March, 2011
Length of study: 12 months
Number of patients enrolled: 40 patients
Location: 4 bed spaces reserved in Level II FICare area
Time Commitment for Parents: Minimum 8 hours each day – during day
< 35 weeks gestation, on low level respiratory support, a primary caregiver parent, willing and able to commit to spending 8 hours per day with their baby between the hours of 0700 and 2000, parental consent.
Palliative care, severe congenital anomaly, critical illness (unlikely to survive), parental request for early transfer, parental inability to participate.
The pilot study enrolled 42 mothers (4 sets of twins), 17 (40%) of whom had other children at home. The majority (22, 55%) were Canadian born; 11 lived in Canada >10 years. All subjects had at least grade 10 high school education; and 27 (71%) were employed outside the home. The subjects varied in age from 23-45 years (mean 33 years).
Key Outcomes of the Pilot Study:
Improved weight gain, fewer nosocomial infections, increased breastfeeding rates, less ROP, and fewer incident reports were filed. Parents also reported decreased parental stress.
* A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit. BMC Pregnancy Childbirth, Volume 13 Suppl 1:S12, 2013
Randomized Control Trial
Length of study: 24 months
Expected completion date: January 2016
Number of centers enrolled: 19 Canadian, 6 Australian, and 1 New Zealand NICUs randomized to FICare or current standard-of-care (13 intervention sites/13 control sites). Teams from the intervention sites received a 2-day workshop on how FICare was to be implemented at their sites.
- All intervention sites were expected to: train nursing staff to support FICare, provide an ongoing parent education program, develop and provide opportunities for veteran parent/peer-to-peer support, and develop environmental and policy supports for FICare
- Each site had a visit by research staff to support and assess the implementation of the model
Infants born < 33 weeks gestation, on low level respiratory support, a primary caregiver parent, willing and able to commit to spending 6 hours per day with their baby between the hours of 0700 and 2000, parental consent.
Palliative care, severe congenital anomaly, critical illness (unlikely to survive), on high level of respiratory support, parental request for early transfer, parental inability to participate.
Outcomes Being Measured:
The primary outcome is weight gain. Secondary outcomes include breastfeeding rates, clinical outcomes, safety, parental stress and anxiety, and resource use.
- Bracht et al. 2013 – FICare parent education
- Galarza-Winton et al. 2013 – FICare nursing education
- Jiang et al. 2014 – Parents as practitioners in preterm care
- Lee and O’Brien 2014 – Parents as primary caregivers in the NICU
- Macdonell et al. 2013 – Engaging veteran parents in FICare
- O’Brien et al. 2013 – FICare pilot study
- Warre et al. 2014 – Parents as the primary caregivers for their infants in the NICU
- O’Brien et al. 2015 (BMC Pediatr.) – FICare Cluster RCT Protocol
- O’Brien et al. 2016 – PAS Late Breaking Abstract: Evaluation of Family Integrated Care (FiCare)