Development of the drug-exposed infant identification algorithm (DEIIA) and its application to measuring part C early intervention referral and eligibility in Massachusetts, 1998-2005

Abstract

The objectives of this study were to develop an algorithm using government-collected administrative data to identify prenatally drug-exposed infants (DEI) and determine the percent who were referred to and eligible for Part C Early Intervention (EI) in Massachusetts. Data from the population-based Pregnancy to Early Life Longitudinal (PELL) Data System were used to develop the Drug-Exposed Infant Identification Algorithm (DEIIA). The DEIIA uses positive toxicology screens on the birth certificate and International Classification of Diseases, 9th Edition, Clinical Modification diagnostic codes in hospital records of the mother (prenatal and birth) and infant (birth and postnatal) to identify infants affected by substance abuse/dependence, withdrawal, and/or prenatal exposure to non-medical use of controlled substances. PELL-EI data linkages were used to determine the percent referred, evaluated, and eligible. The DEIIA identified 7,348 drug-exposed infants born in Massachusetts from 1998 to 2005 to resident mothers (1.2 % of all births). Most DEI (82.6 %) were identified from maternal/infant birth hospital records. Sixty-one percent of all DEI were referred to EI; 87.2 % of those referred were evaluated, and 89.4 % of those evaluated were found eligible. EI data contained information on drug exposure for 59.9 % of referred DEI. Only 2.8 % of MA resident births who were referred to EI but not identified by the DEIIA had drug indicators in EI data. DEI referrals to EI are federally mandated, but many are not referred. The DEIIA uses data available in most states and could be used as a public health screening tool to improve access to developmental services for DEI.