Factors Associated with Successful First High-Risk Infant Clinic Visit for Very Low Birth Weight Infants in California

Susan R Hintz; Jeffrey B Gould; Mihoko V Bennett; Tianyao Lu; Erika E Gray; Maria A L Jocson; Martha G Fuller; Henry C Lee

doi:10.1016/j.jpeds.2019.03.007

Factors Associated with Successful First High-Risk Infant Clinic Visit for Very Low Birth Weight Infants in California

J Pediatr. 2019 Jul:210:91-98.e1. doi: 10.1016/j.jpeds.2019.03.007. Epub 2019 Apr 6.

Authors

Susan R Hintz¹, Jeffrey B Gould², Mihoko V Bennett², Tianyao Lu², Erika E Gray², Maria A L Jocson³, Martha G Fuller⁴, Henry C Lee²

Affiliations

¹ Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA; California Perinatal Quality of Care Collaborative, Palo Alto, CA. Electronic address: srhintz@stanford.edu.
² Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA; California Perinatal Quality of Care Collaborative, Palo Alto, CA.
³ California Children's Services, Integrated Systems of Care, Department of Health Care Services, Sacramento, CA.
⁴ Department of Pediatrics, University of California San Diego, San Diego, CA.

PMID: 30967249
DOI: 10.1016/j.jpeds.2019.03.007

Abstract

Objectives: To determine rates of at least 1 high-risk infant follow-up (HRIF) visit by 12 months corrected age, and factors associated with successful first visit among very low birth weight (VLBW) infants in a statewide population-based setting.

Study design: We used the linked California Perinatal Quality of Care Collaborative and California Perinatal Quality of Care Collaborative-California Children's Services HRIF databases. Multivariable logistic regression examined independent associations of maternal, sociodemographic, neonatal clinical, and HRIF program factors with a successful first HRIF visit among VLBW infants born in 2010-2011.

Results: Among 6512 VLBW children referred to HRIF, 4938 (76%) attended a first visit. Higher odds for first HRIF visit attendance was associated with older maternal age (OR, 1.48; 95% CI, 1.27-1.72; 30-39 vs 20-29 years), lower birth weight (OR, 2.11; 95% CI, 1.69-2.65; ≤750 g vs 1251-1499 g), private insurance (OR, 1.65; 95% CI, 1.19-2.31), a history of severe intracranial hemorrhage (OR, 1.61; 95% CI, 1.12-2.30), 2 parents as primary caregivers (OR, 1.18, 95% CI 1.03-1.36), and higher HRIF program volume (OR, 2.62; 95% CI, 1.88-3.66; second vs lowest quartile); and lower odds with maternal race African American or black (OR, 0.65; 95% CI, 0.54-0.78), and greater distance to HRIF program (OR, 0.69; 95% CI, 0.57-0.83). Rates varied substantially across HRIF programs, which remained after risk adjustment.

Conclusions: In a population-based California VLBW cohort, maternal, sociodemographic, and home- and program-level disparities were associated with HRIF non-attendance. These findings underscore the need to identify challenges in access and resource risk factors during hospitalization in the neonatal intensive care unit, provide enhanced education about the benefits of HRIF, and create comprehensive neonatal intensive care unit-to-home transition approaches.

Keywords: disparity; neurodevelopmental; premature; referral.

MeSH terms

Ambulatory Care / statistics & numerical data*
California
Child Health Services / statistics & numerical data*
Female
Follow-Up Studies
Humans
Infant
Infant, Very Low Birth Weight*
Male
Program Evaluation
Prospective Studies
Risk Assessment
Risk Factors